Correlation Analysis Of IMA And The Severity Of Coronary Artery Disease In Premature Acute Coronary Syndrome

Objective:This study compared ischemia modified albumin(IMA)levels in the premature acute coronary syndrome(PACS)group and the control(CON)group,explore the correlation between IMA level and PACS and Analyze the correlation between the severity of coronary artery disease in patients with IMA levels and PACS.Methord:Selected patients who were hospitalized in the Department of Cardiology,Cardiovascular and Cerebrovascular Disease Hospital of Yan’an University Affiliated Hospital from January 2018 to August 2020 due to chest tightness,chest pain,shortness of breath and other suspected coronary heart disease,and screened patients ≤55 years old for men and ≤65 years old for women.A total of 284 cases,including 163 males,aged48.50±5.756 years old,and 121 females,aged 58.07±5.032 years old.Collect the general clinical data and IMA and other biochemical indicators of all patients in the case retrieval software of our hospital and record all the data.All patients were divided into PACS group(212 cases)and CON group(72 cases)according to the results of coronary angiography.The PACS group was further divided into unstable angina pectoris(UAP)group(122 cases)and acute myocardial infarction(AMI)group(90 cases)based on clinical manifestations,biochemical indicators and various auxiliary examinations.The AMI group includes non-ST segment elevation myocardial infarction(NSTEMI)and ST elevation myocardial infarction(STEMI),and the GENSINI score was used to assess the severity of coronary artery lesions for all PACS patients.According to the GENSINI score,they were divided into a high GENSINI score(GENSINI score ≥ 40 points)group(87 cases)and a low GENSINI score(GENSINI score <40 points)group(125 cases).The ischemia modified albumin(IMA)group was further divided into high-level group(≥60k U/L)and low-level group(<60k U/L).The binary logistic regression method was used to analyze the independent risk factors of PACS patients and the influencing factors of high GENSINI score;analyze the diagnostic value of high-level IMA to PACS,and compare the prevalence of AMI between high-level and low-level groups;analysis the correlation between the UAP group and the AMI group and the GENSINI score and the characteristics of coronary artery lesions between the two groups.Results:1.Compared with the CON group,the PACS group had higher male,smoking history,diabetes history,family history of coronary heart disease,IMA,UA,Hb A1 c,creatinine(CREA),low density lipoprotein cholesterol(LDL-C)and left ventricular ejection fraction(LVEF),and the differences were statistically significant(P < 0.05).The level of high-density lipoprotein cholesterol(HDL-C)in the PACS group was lower than that in the CON group,with statistical significance(P=0.034).There were no significant differences in age,history of hypertension,body mass index(BMI),cystin-C(Cys-C),γ-glutamyltransferase(GGT),total cholesterol(TC),apolipoprotein a(LP(a)),triglyceride(TG),serum total bilirubin(TBil)and fibrinogen(FIB)between the two groups(P > 0.05).2.Binary Logistic regression analysis found that Hb A1 c,IMA,LDL-C,and smoking were independent risk factors for PACS patients(OR=2.211,95%CI=1.255-3.895,P=0.006,OR=1.067,95%CI=1.021-1.115,P=0.004,OR=1.996,95%CI=1.159-3.437,P=0.013,OR=3.003,95%CI=1.232-7.317,P=0.016).3.Using ROC curve to analyze the diagnostic value of IMA for PACS,the results showed that the area under the ROC curve(AUC)=0.652,95%CI=0.566-0.737,P=0.001.When the critical value of IMA=59.35 k U/L,the maximum Youden index is 0.279,which has the greatest diagnostic value for PACS.The sensitivity and specificity are 87.6% and40.3%,respectively.4.The incidence of AMI in the high IMA level group was significantly higher than that of UAP,and the difference was statistically significant(P=0.041).5.There are differences in smoking history,dyslipidemia,LVEF,LDL-C between the high GENSINI score group and the low GENSINI score group,and the difference is statistically significant(P<0.05).Further binary Logistic regression analysis found that smoking and dyslipidemia were high Independent risk factors for GENSIN score(OR=2.238,95%CI=1.231-4.069,P=0.008,OR=2.116,95%CI=1.086-4.125,P=0.028).6.The Gensini scores of the UAP group and the AMI group were compared,and the results showed that the Gensini scores of the AMI group were higher than the UAP group,and the difference was significant(132.42 vs.90.41,P=0.000).7.Comparing the characteristics of coronary artery lesions between the UAP group and the AMI group,the results showed that the AMI group had more single-vessel lesions than the UAP group(42.22%vs.23.77%,P=0.004),and the AMI group had more anterior descending artery lesions than the UAP group(28.70 %vs.14.40%,P=0.017),the stent diameter in the AMI group was larger than that in the UAP group(3.08±0.46 vs.2.88±0.45,P=0.003),and all the difference was statistically significant(P<0.05).Conclusion:1.High IMA level is correlated with PACS,and when IMA≥59.35 k U/L,it has high diagnostic value for PACS,it is suggested that elevated IMA can identify the occurrence of PACS early;2.There is no correlation between IMA and high GENSINI score,suggesting that there is no correlation between IMA and PACS severity of coronary artery disease.