Study On Risk Factors Of Coronary Artery Lesion Severity In Middle-aged And Elderly Patients With Acute Coronary Syndrome

ObjectiveTo explore the correlation between the potential risk factors of coronary heart disease and the severity of coronary artery lesions in middle-aged and elderly patients with acute coronary syndrome,and to provide some clinical basis for further improving the prevention and treatment of middle-aged and elderly patients with acute coronary syndrome.MethodsIn this clinical study,we retrospectively analyzed 515 middle-aged and elderly patients diagnosed with acute coronary syndrome from January 2018 to January 2023,and collected demographic characteristics and medical history data of patients,such as age,gender,history of hypertension,history of diabetes,etc.;Laboratory parameters such as blood glucose,blood lipids,uric acid,homocysteine,lipoprotein-associated phospholipase A2,mean platelet volume,etc.were collected.The primary end point was the severity of coronary artery disease,which was expressed by the number of coronary artery disease and coronary Gensini score respectively.The secondary end points were CTO,the extent of coronary artery disease and whether PCI was performed.The baseline table was made according to the number of coronary artery lesions,the degree of coronary artery lesions(Gensini score)and the extent of coronary artery lesions.The potential factors related to the above indicators and the primary endpoint and secondary endpoint were analyzed by univariate andmultivariate Logistic regression analysis.ResultsThe mean age of the total population was 63.4 years;Among them,65.2%of patients were male,71.46%of patients with unstable angina pectoris,13.79%of patients with non-ST-segment elevation myocardial infarction and 14.75%of patients with acute ST-segment elevation myocardial infarction.Of the total study population,44.3%had a history of smoking,65.6%had a history of hypertension,27.4%had a history of diabetes,14.2%had a history of previous cerebral infarction,and 64.7%had hyperuricemia,with a median Gensini score of 3 2.Multi variate logistic regression analysis showed that age[OR=1.051,95%confidence interval(1.030,1.074)]and glycosylated hemoglobin[OR=1.204,95%confidence interval(1.012,1.432)]were still associated with multivessel coronary artery disease after adjusting for type of acute coronary syndrome,gender and smoking(P<0.05).Hyperuricemia[OR=1.695,95%CI(1.067,2.692),P=0.025]and homocysteine[OR=1.099,95%CI(1.017,1.186),P=0.016]were significantly associated with moderate to severe coronary artery disease(Gensini score ≥28)compared with mild coronary artery disease(Gensini score ≤27).When HbAlc=6.7 was the best threshold for multivessel disease,the area under the curve was 0.546,the sensitivity was 0.249,and the specificity was 0.856;When homocysteine(Hcy)=12.1 μmol/L,it was the best threshold for predicting moderate to severe coronary lesions(Gensini score ≥28),with an area under the ROC curve of 0.62,a sensitivity of 0.529,and a specificity of 0.71.For the severity of coronary artery disease(Gensini score),Spearman correlation analysis showed that uric acid(r=0.143,P=0.024),TyG index(r=0.175,P=0.005),glycosylated hemoglobin(r=0.0.199,P=0.009)and homocysteine(r=0.164,P<0.001)were independently correlated with the severity of coronary artery disease.ConclusionAge and HbAlc were independent risk factors for the severity of coronary artery disease.Hyperuricemia and homocysteine were independent risk factors for moderate to severe coronary artery lesions(Gensini score≥28).Male,smoking and NLR were risk factors for coronary artery stenosis.