Kozieł-Siołkowska Monika, Mitręga Katarzyna, Podolecki Tomasz, Olma Anna, Kalarus Zbigniew, Streb Witold
1st Department of Cardiology and Angiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland.
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
J Clin Med. 2024 Nov 24;13(23):7109. doi: 10.3390/jcm13237109.
Increased lipoprotein(a) [Lp(a)] level is associated with elevated possibility of atherosclerosis progression. SYNTAX score enables to grade the anatomy of coronary arteries. To identify the impact of increased Lp(a) level on SYNTAX score in individuals with acute myocardial infarction (AMI). In our analysis, we enrolled 173 consecutive adult patients hospitalized for AMI in a tertiary cardiology center from December 2022 to August 2023. Patient characteristics were compared for patients with SYNTAX score ≥ 23 (64 patients) and SYNTAX score < 23 (109 patients). The SYNTAX score was estimated based on the results of coronary angiography. Logistic regression analyses were performed to evaluate the factors associated with SYNTAX score. Individuals with the SYNTAX score ≥ 23 were more likely to have arterial hypertension, diabetes mellitus, significant stenosis in the left main coronary artery, and higher Lp(a) levels than those with SYNTAX < 23 (all < 0.05). On univariate analysis, age (OR 1.05, 95% CI 1.02-1.08, = 0.001), Lp(a) levels (OR 1.04, 95% CI 1.01-1.06, = 0.001), and arterial hypertension (OR 2.69, 95% CI 1.26-5.74, = 0.011) were associated with SYNTAX score ≥ 23. Multivariable determinants of SYNTAX score ≥ 23 were as follows: Lp(a) levels (OR 1.03, 95% CI 1.01-1.08, = 0.029), and age (OR 1.04, 95% CI 1.01-1.07, = 0.005). The cut-off value for Lp(a) 166.16 nmol/L identifies patients with SYNTAX score ≥ 23 with 97% sensitivity and 44% specificity (area under curve 0.78, < 0.001). Elevated Lp(a) concentration is associated with a higher SYNTAX score. A cut-off value of Lp(a) above 166.16 nmol/L allows us to identify subjects with SYNTAX score ≥ 23 with good specificity and sensitivity.
脂蛋白(a)[Lp(a)]水平升高与动脉粥样硬化进展可能性增加相关。SYNTAX评分能够对冠状动脉解剖结构进行分级。旨在确定Lp(a)水平升高对急性心肌梗死(AMI)患者SYNTAX评分的影响。在我们的分析中，我们纳入了2022年12月至2023年8月在一家三级心脏病中心因AMI住院的173例连续成年患者。比较了SYNTAX评分≥23分的患者(64例)和SYNTAX评分<23分的患者(109例)的患者特征。SYNTAX评分根据冠状动脉造影结果进行评估。进行逻辑回归分析以评估与SYNTAX评分相关的因素。与SYNTAX评分<23分的患者相比，SYNTAX评分≥23分的患者更有可能患有动脉高血压、糖尿病、左主干冠状动脉严重狭窄以及Lp(a)水平更高(均P<0.05)。单因素分析显示，年龄(比值比[OR]1.05，95%置信区间[CI]1.02-1.08，P=0.001)、Lp(a)水平(OR 1.04，95%CI 1.01-1.06，P=0.001)和动脉高血压(OR 2.69，95%CI 1.26-5.74，P=0.011)与SYNTAX评分≥23分相关。SYNTAX评分≥23分的多变量决定因素如下：Lp(a)水平(OR 1.03，95%CI 1.01-1.08，P=0.029)和年龄(OR 1.04，95%CI 1.01-1.07，P=0.005)。Lp(a)的截断值为166.16 nmol/L时，识别SYNTAX评分≥23分患者的敏感度为97%，特异度为44%(曲线下面积0.78，P<0.001)。Lp(a)浓度升高与更高的SYNTAX评分相关。Lp(a)高于166.16 nmol/L的截断值使我们能够以良好的特异度和敏感度识别SYNTAX评分≥23分的受试者。
