Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Cardiol J. 2024;31(2):251-260. doi: 10.5603/CJ.a2022.0058. Epub 2022 Jun 28.
Dyslipidemia plays a pivotal role in the pathogenesis of acute coronary syndrome (ACS). This study aims to investigate the value of two indices associated with lipid metabolism, low-density lipoprotein cholesterol to apolipoprotein B ratio (LBR) and high-density lipoprotein cholesterol to apolipoprotein A-1 ratio (HAR), to predict in-hospital death in patients with ACS.
This single-center, retrospective, observational study included 3,366 consecutive ACS patients in Zhongda Hospital, Southeast University from July 2013 to January 2018. The clinical and laboratory data were extracted, and the in-hospital death and hospitalization days were also recorded.
All patients were equally divided into four groups according to quartiles of HAR: Q1 (HAR < 1.0283), Q2 (1.0283 ≤ HAR < 1.0860), Q3 (1.0860 ≤ HAR < 1.1798), and Q4 (HAR ≥ 1.1798). Overall, HAR was positively associated with the counts of neutrophils and monocytes, whereas negatively correlated to lymphocyte counts. HAR was negatively correlated to left ventricular ejection fraction (LVEF). Compared to other three groups, in-hospital mortality (vs. Q1, Q2, and Q3, p < 0.001) and hospitalization length (vs. Q1, Q2, and Q3, p < 0.001) were significantly higher in the Q4 group. When grouped by LBR, however, there was no significant difference in LVEF, in-hospital mortality, and hospitalization length among groups. After adjusting potential impact from age, systolic blood pressure, creatine, lactate dehydrogenase, albumin, glucose, and uric acid, multivariate analysis indicated that HAR was an independent factor predicting in-hospital death among ACS patients.
HAR had good predictive value for patients' in-hospital death after the occurrence of acute coronary events, but LBR was not related to in-hospital adverse events.
脂代谢异常在急性冠状动脉综合征（ACS）的发病机制中起着关键作用。本研究旨在探讨与脂代谢相关的两个指标——低密度脂蛋白胆固醇与载脂蛋白 B 比值（LBR）和高密度脂蛋白胆固醇与载脂蛋白 A-1 比值（HAR）——预测 ACS 患者住院期间死亡的价值。
这是一项单中心、回顾性、观察性研究，纳入了 2013 年 7 月至 2018 年 1 月期间东南大学附属中大医院的 3366 例连续 ACS 患者。提取了临床和实验室数据，并记录了住院期间的死亡和住院天数。
根据 HAR 的四分位数将所有患者分为四组：Q1（HAR<1.0283）、Q2（1.0283≤HAR<1.0860）、Q3（1.0860≤HAR<1.1798）和 Q4（HAR≥1.1798）。总体而言，HAR 与中性粒细胞和单核细胞计数呈正相关，与淋巴细胞计数呈负相关。HAR 与左心室射血分数（LVEF）呈负相关。与其他三组相比，Q4 组的住院期间死亡率（与 Q1、Q2 和 Q3 相比，p<0.001）和住院时间（与 Q1、Q2 和 Q3 相比，p<0.001）均显著更高。然而，按 LBR 分组时，各组之间的 LVEF、住院期间死亡率和住院时间无显著差异。在校正年龄、收缩压、肌酐、乳酸脱氢酶、白蛋白、葡萄糖和尿酸等潜在影响因素后，多变量分析表明 HAR 是 ACS 患者住院期间死亡的独立预测因素。
HAR 对急性冠状动脉事件发生后患者的住院期间死亡具有良好的预测价值，而 LBR 与住院期间不良事件无关。
