The Predictive Value Of SYNTAX And SYNTAX Ⅱ Scores On Clinical Prognosis Of Coronary Artery Disease And Association Study With The Metabolome

Coronary artery disease(CAD)is a disease with high morbidity and mortality around the world.Coronary angiography(CAG)is a key method for the diagnosis of CAD.SYNTAX score is an important evaluation index to evaluate the anatomical complexity and severity of coronary stenosis based on CAG results.SYNTAX Ⅱ score is a comprehensive evaluation of patients’ prognosis which combined SYNTAX score and clinical factors.Both these two scores are important indicators for evaluating the severity of CAD and predicting the prognosis of the disease in clinical research.The occurrence and development of CAD are closely related to metabolic disorders in the body,and the difference in metabolome affects the clinical prognosis of patients.Studying the correlation between metabolome and disease severity,can discovery changes in the level of small molecule metabolites in the body and reveal the pathophysiological progress of the disease,while these has been rarely reported in the Chinese population.Therefore,this study is about the correlation of SYNTAX and SYNTAX Ⅱ scores with poor clinical outcomes and metabolomics in Chinese CAD patients,and aims to evaluate the predictive efficacy of SYNTAX and SYNTAX Ⅱ scores on poor clinical outcomes,and find metabolites and corresponding metabolic pathways that associated with the severity of CAD,and study the effects of these metabolites on cardiomyocyte hypoxic damage in cell models.Firstly,1506 CAD patients were recruited and followed up,SYNTAX and SYNTAX Ⅱ scores were calculated to evaluate the association and predictive effect with poor clinical outcomes including death events and major cardiovascular adverse events(MACE).The results showed that the risk of poor clinical outcomes was significantly increased with the increasing SYNTAX and SYNTAX Ⅱ scores,and SYNTAX score is an independent predictor of the risk of death and MACE events.Secondly,widely-targeted metabolomic profiling was used to detect the concentration of 274 metabolites in plasma of 1015 CAD patients,and the correlation between metabolites and the severity of CAD was analyzed.The results showed that 7 metabolites were significantly related to the severity of CAD,tryptophan(TRP),glutamine,and lysine were significantly negatively correlated,while 3-hydroxybutyrate,linoleic acid(C18: 2n6c),lauric acid / dodecane Acid(C12: 0)and chenodeoxyglycolic acid were significantly positively correlated.Finally,we studied the effects of different concentrations of TRP,kynurenine(KYN),indoleacetic acid(IAA),and indolepropionic acid(IPA)on H9c2 cardiomyocyte which were suffered hypoxia/reoxygenation(H/R)injury.The results showed that TRP increased the cell viability of model cells and reduced cell injury;while KYN decreased the cell viability of model cells and increased the level of oxidative stress in cells.In summary,this study is a correlation study between the SYNTAX and SYNTAX Ⅱ scores and disease prognosis and metabolomics in Chinese CAD patients.The predictive effects of SYNTAX and SYNTAX Ⅱ scores on poor clinical outcome were evaluated.TRP and KYN,3-hydroxybutyrate,chenodeoxyglycolic acid and other significant metabolites related to the severity of CAD,and the different effects of TRP and KYN on hypoxic injury were investigated in cardiomyocytes.This study provides a reference for the mechanism research of poor prognosis and disease progression of CAD.