Study On The Correlation Between Residual Cholesterol Risk And Plaque Characteristics In Patients With Acute Coronary Syndrome Using OCT

Objective: Elevated low-density lipoprotein cholesterol(LDL-C)is an important risk factor for the occurrence of acute coronary syndrome(ACS).Although the use of statins and ezemab can significantly reduce the incidence of acute cardiovascular events,there is still a risk of cardiovascular events.Therefore,The study put forward the concept of residual cholesterol risk(RCR),which refers to the low density lipoprotein cholesterol ≥ 1.8mmol/L in patients undergoing treatment.Optical coherence tomography(OCT)is an intravascular imaging method used to evaluate the characteristics of vascular plaque in patients with acute coronary syndrome,identify unstable vulnerable plaque,thin cap atheromatous plaque(TCFA),plaque rupture(PR),thrombus,etc.It can help doctors to judge and deal with this disease more accurately.This study applies OCT to investigate the correlation between residual cholesterol risk and plaque characteristics in patients with acute coronary syndrome.Methods: From December 2019 to December 2021,138 patients with ACS who were diagnosed in the Department of Cardiology of our hospital and underwent coronary angiography(CAG)and OCT examinations were collected.A total of 98 patients with ACS were enrolled after admission and exclusion.Collect the complete clinical data of the hospitalized patients,the biochemical indexes of the first fasting venous blood,and divide the patients into RCR group(LDL-C ≥ 1.8mmol/L,a total of 58 cases)and non-RCR group(LDL-C<1.8mmol/L,a total of 40 cases)based on the LDL-C level of 1.8mmol/L;Coronary angiography and OCT were used to collect the culprit vessel location,plaque shape and nature,plaque rupture,and measure the thickness of the thinnest fiber cap of the plaque.SPSS26.0 statistical software was used to analyze the clinical data and OCT data of each group.P<0.05 is statistically significant.Results: 1.The BMI,STEMI and NSTEMI incidence rate,uric acid level,total cholesterol level,triglyceride TG,low-density lipoprotein cholesterol LDL-C,blood glucose and other indicators of patients in the RCR group were significantly higher than those in the non RCR group.However,the incidence of UAP and previous coronary heart disease with stent implantation were lower than those in non-RCR group(P<0.05).2.The detection rate of lipid plaque in RCR group was higher than that in non-RCR group(96.55% vs 75.00%,P<0.001);The average thickness of the thinnest fiber cap was thinner than that of the non-RCR group(70.19 ± 19.40 vs 79.10 ± 13.92,P<0.05);The detection rate of TCFA was higher than that of non-RCR group(50.00% vs 20.00%,P<0.003);The angle of lipid core is larger than that of non-RCR,with 180-360 °(72.41% vs 40.00%,P<0.002);The detection rate of plaque rupture was higher than that of non-RCR group(27.59% vs 5.00%,P<0.05).3.Comparison between TCFA group and non TCFA group: diabetes(OR: 2.810 and 95% CI(1.157,6.824),P<0.022),RCR(OR: 3.897 and 95% CI(1.500,10.124),P<0.005).Through TCFA multiple cause logistic regression analysis,It was concluded that diabetes and RCR were independent risk factors for TCFA in ACS patients(P<0.05).Conclusions: 1.Patients with acute coronary syndrome who are at risk of residual cholesterol have thinner fibrous caps,more lipid plaques,more prone to thin fibrous cap atherosclerotic plaque(TCFA),increased plaque rupture rate,and more vulnerable coronary plaque phenotype.2.The risk of residual cholesterol is an independent risk factor of TCFA in patients with acute coronary syndrome,and may be used as a predictor of coronary plaque stability.