Bilgin Murat, Akkaya Emre, Dokuyucu Recep
Department of Cardiology, Private Aktif International Hospital, Yalova 77720, Turkey.
Department of Cardiology, Bossan Hospital, Gaziantep 27580, Turkey.
J Clin Med. 2024 Aug 16;13(16):4832. doi: 10.3390/jcm13164832.
We aimed to evaluate the predictive importance of various clinical and laboratory parameters in the differential diagnosis of Acute Coronary Syndrome (ACS). Understanding these predictors is critical for improving diagnostic accuracy, guiding therapeutic decisions, and ultimately enhancing patient outcomes. The study included a total of 427 patients diagnosed with ACS, comprising 142 with unstable angina, 142 with non-ST elevation myocardial infarction (NSTEMI), and 143 with ST elevation myocardial infarction (STEMI). The data were collected from medical records of patients treated at a tertiary care hospital between January 2020 and December 2024. In addition to other biochemical parameters, triglyceride/HDL ratio (THR), triglyceride-glucose index (TGI), and Pan-Immune-Inflammation Value (PIV) were calculated and compared. THR, TGI, PIV, and mortality rate were statistically higher in the STEMI group ( = 0.034, = 0.031, = 0.022, = 0.045, respectively). The risk factors were found to be significantly associated with STEMI in the multiple logistic regression analysis and included age, total cholesterol, triglycerides, diabetes mellitus, smoking, cTnI, LVEF, THR, TGI, and PIV. High THR increases the risk of STEMI (AUC = 0.67, 95% CI: 0.62-0.72, = 0.020). High THR increases the risk of mortality in ACS patients (AUC = 0.70, 95% CI: 0.65-0.75, = 0.004). THRs above 3.5 are associated with higher risk. Sensitivity is 75% and specificity is 60%. High TGI increases the risk of mortality in ACS patients (AUC = 0.73, 95% CI: 0.68-0.78, = 0.007). TGIs above 8.5 are associated with higher risk. Sensitivity is 78% and specificity is 63%. High PIVs increase the risk of mortality in ACS patients (AUC = 0.75, 95% CI: 0.70-0.80, = 0.009). PIVs above 370 are associated with higher risk. Sensitivity is 80% and specificity is 65%. The combination of TGI, THR, PIV, and cTnI has the highest predictive capability over individual parameters for STEMI and mortality. We found that age, total cholesterol, triglycerides, cTnI, THR, TGI, and PIV increase, low LVEF, presence of diabetes mellitus, and smoking have predictive values for STEMI and mortality in patients with ACS. Unlike the studies in the literature, this is the first study in which cTnI, THR, TGI, and PIV values were evaluated together in ACS and mortality prediction.
我们旨在评估各种临床和实验室参数在急性冠状动脉综合征（ACS）鉴别诊断中的预测重要性。了解这些预测因素对于提高诊断准确性、指导治疗决策以及最终改善患者预后至关重要。该研究共纳入427例诊断为ACS的患者，其中142例为不稳定型心绞痛，142例为非ST段抬高型心肌梗死（NSTEMI），143例为ST段抬高型心肌梗死（STEMI）。数据收集自2020年1月至2024年12月在一家三级护理医院接受治疗的患者的病历。除其他生化参数外，还计算并比较了甘油三酯/高密度脂蛋白比值（THR）、甘油三酯 - 葡萄糖指数（TGI）和全免疫炎症值（PIV）。STEMI组的THR、TGI、PIV和死亡率在统计学上更高（分别为P = 0.034、P = 0.031、P = 0.022、P = 0.045）。在多因素逻辑回归分析中发现这些危险因素与STEMI显著相关，包括年龄、总胆固醇、甘油三酯、糖尿病、吸烟、肌钙蛋白I（cTnI）、左心室射血分数（LVEF）、THR、TGI和PIV。高THR增加STEMI风险（AUC = 0.67，95%CI：0.62 - 0.72，P = 0.020）。高THR增加ACS患者的死亡风险（AUC = 0.70，95%CI：0.65 - 0.75，P = 0.004）。THR高于3.5与更高风险相关。敏感性为75%，特异性为60%。高TGI增加ACS患者的死亡风险（AUC = 0.73，95%CI：0.68 - 0.78，P = 0.007）。TGI高于8.5与更高风险相关。敏感性为78%，特异性为63%。高PIV增加ACS患者的死亡风险（AUC = 0.75，95%CI：0.70 - 0.80，P = 0.009）。PIV高于370与更高风险相关。敏感性为80%，特异性为65%。TGI、THR、PIV和cTnI的组合对STEMI和死亡率的预测能力高于单个参数。我们发现年龄、总胆固醇、甘油三酯、cTnI、THR、TGI和PIV升高、低LVEF、糖尿病的存在以及吸烟对ACS患者的STEMI和死亡率具有预测价值。与文献中的研究不同，这是第一项在ACS和死亡率预测中同时评估cTnI、THR、TGI和PIV值的研究。
