Association of Severity of Coronary Artery Disease With Traditional Risk Factors, Clinical Characteristics and Carotid Plaque Burden in Patients With Acute Coronary Syndrome.

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2024-12-25 DOI:10.18087/cardio.2024.12.n2686

L L Bershtein, M D Lunina, D S Evdokimov, T V Nayden, V E Gumerova, I N Kochanov, A A Ivanov, S A Boldueva, E D Resnyanskaya, E V Zbyshevskaya, A E Evtushenko, V Kh Piltakyan, S A Sayganov

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引用次数: 0

Abstract

Aim: To study the associations between risk factors, clinical characteristics, severity of brachiocephalic artery (BCA) atherosclerosis and severity of coronary artery (CA) disease in patients with acute coronary syndrome (ACS).

Material and methods: The study included patients with any type of ACS and obstructive coronary artery disease confirmed by coronary angiography. A quantitative analysis of coronary angiography data was performed with an assessment of the number of CAs with significant stenosis and calculation of the SYNTAX score. The major clinical and laboratory parameters that are risk factors for atherosclerosis and/or affect the cardiovascular prognosis were assessed; for patients with ACS without ST segment elevation (NSTE-ACS), the risk score was calculated by the GRACE scale. The BCA ultrasound examination was performed with a quantitative analysis of atherosclerotic burden.

Results: The study included 312 patients aged 64 [56, 72] years; the proportion of men was 69.2%. The frequency of lesions of 1, 2 and 3 coronary arteries was 34.6, 35.3, and 30.1%, respectively; the SYNTAX score was 14 [9, 21]. According to the results of univariate analysis, the number of stenotic CAs and the SYNTAX score were associated with age, smoking history, history of ischemic heart disease, diabetes mellitus (DM), the presence of non-stenotic CA lesions, the GRACE score in NSTE-ACS, and the Charlson comorbidity index. An inverse correlation was found for the level of physical activity and a slightly weaker one for the glomerular filtration rate and high-density lipoprotein cholesterol (HDL-C). In multivariate models, the only independent predictors of the number of stenotic CAs were HDL-C (odds ratio, OR 0.37, 95% confidence interval, CI 0.17-0.81; p=0.012) and the smoking history (OR 1.30, 95% CI 1.12-1.52; p=0.001), a coefficient of determination of the model R2 of 18%, SYNTAX score with a history of myocardial infarction (ß=6.40, 95% CI 3.22-9.58; p<0.001), insulin-dependent DM (ß=9.44, 95% CI 3.50-15.38; p=0.002), GRACE score for NSTE-ACS (ß=0.06, 95% CI 0.01-0.11; p<0.014), and a coefficient of determination of the model R2=20%.

Conclusion: Patients with ACS show significant, independent associations of the severity of coronary atherosclerosis with HDL-C, smoking duration, history of myocardial infarction, insulin-dependent diabetes, and the GRACE score in NSTE-ACS. Variability in the severity of CA lesions is only to a small extent determined by risk factors, clinical characteristics, and the severity of concomitant carotid atherosclerosis.

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急性冠状动脉综合征患者冠状动脉疾病严重程度与传统危险因素、临床特征和颈动脉斑块负荷的关系

目的：探讨急性冠脉综合征（ACS）患者的危险因素、临床特征、头臂动脉（BCA）粥样硬化严重程度与冠状动脉病变严重程度的关系。材料和方法：本研究纳入经冠状动脉造影证实的任何类型ACS和阻塞性冠状动脉疾病患者。对冠状动脉造影数据进行定量分析，评估明显狭窄的ca数量并计算SYNTAX评分。评估作为动脉粥样硬化危险因素和/或影响心血管预后的主要临床和实验室参数；对于无ST段抬高的ACS （NSTE-ACS）患者，采用GRACE量表计算风险评分。BCA超声检查定量分析动脉粥样硬化负荷。结果：本研究纳入312例患者，年龄64[56,72]岁；男性占69.2%。1、2、3冠状动脉病变发生率分别为34.6、35.3、30.1%；SYNTAX评分为14分[9,21]。单因素分析结果显示，狭窄性CA的数量和SYNTAX评分与年龄、吸烟史、缺血性心脏病史、糖尿病（DM）、非狭窄性CA病变的存在、NSTE-ACS的GRACE评分和Charlson合并症指数相关。体力活动水平呈负相关，肾小球滤过率和高密度脂蛋白胆固醇（HDL-C）呈弱相关。在多变量模型中，狭窄性ca数量的唯一独立预测因子是HDL-C(比值比，OR 0.37, 95%可信区间，CI 0.17-0.81；p=0.012)和吸烟史(OR 1.30, 95% CI 1.12-1.52；p=0.001)，模型决定系数R2为18%，SYNTAX评分与心肌梗死史(ß=6.40, 95% CI 3.22-9.58；p<0.001)，胰岛素依赖型糖尿病(ß=9.44, 95% CI 3.50-15.38；p=0.002)， NSTE-ACS的GRACE评分(ß=0.06, 95% CI 0.01-0.11；p<0.014)，模型的决定系数R2=20%。结论：ACS患者冠状动脉粥样硬化严重程度与HDL-C、吸烟时间、心肌梗死史、胰岛素依赖型糖尿病、NSTE-ACS GRACE评分有显著的独立相关性。CA病变严重程度的变异性仅在很小程度上取决于危险因素、临床特征和伴发颈动脉粥样硬化的严重程度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.