Bershtein L L, Lunina M D, Evdokimov D S, Nayden T V, Gumerova V E, Kochanov I N, Ivanov A A, Boldueva S A, Resnyanskaya E D, Zbyshevskaya E V, Evtushenko A E, Piltakyan V Kh, Sayganov S A
Mechnikov North-Western State Medical University, St. Petersburg.
Saint Petersburg Municipal Pokrov Hospital, St. Petersburg.
Kardiologiia. 2024 Dec 25;64(12):44-50. doi: 10.18087/cardio.2024.12.n2686.
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).
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.
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%.
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.
研究急性冠状动脉综合征（ACS）患者的危险因素、临床特征、头臂动脉（BCA）动脉粥样硬化严重程度与冠状动脉（CA）疾病严重程度之间的关联。
本研究纳入了经冠状动脉造影确诊为任何类型ACS和阻塞性冠状动脉疾病的患者。对冠状动脉造影数据进行定量分析，评估存在显著狭窄的冠状动脉数量并计算SYNTAX评分。评估了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，通过GRACE量表计算风险评分。对头臂动脉进行超声检查并对动脉粥样硬化负荷进行定量分析。
本研究纳入了312例年龄为64[56,72]岁的患者；男性比例为69.2%。单支、双支和三支冠状动脉病变的频率分别为34.6%、35.3%和30.1%；SYNTAX评分为14[9,21]。根据单因素分析结果，狭窄冠状动脉数量和SYNTAX评分与年龄、吸烟史、缺血性心脏病史、糖尿病（DM）、非狭窄冠状动脉病变的存在、NSTE-ACS中的GRACE评分以及Charlson合并症指数相关。发现体力活动水平与之呈负相关，而肾小球滤过率和高密度脂蛋白胆固醇（HDL-C）与之呈稍弱的负相关。在多变量模型中，狭窄冠状动脉数量的唯一独立预测因素是HDL-C（比值比，OR 0.37，95%置信区间，CI 0.17-0.81；p=0.012）和吸烟史（OR 1.30，95%CI 1.12-1.52；p=0.001），模型的决定系数R2为18%，SYNTAX评分与心肌梗死病史（ß=6.40，95%CI 3.22-9.58；p<0.001）、胰岛素依赖型DM（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）相关，模型的决定系数R2=20%。
ACS患者冠状动脉粥样硬化严重程度与HDL-C、吸烟时长、心肌梗死病史、胰岛素依赖型糖尿病以及NSTE-ACS中的GRACE评分之间存在显著的独立关联。冠状动脉病变严重程度的变异性仅在很小程度上由危险因素、临床特征和伴发的颈动脉粥样硬化严重程度所决定。
