Yilmaz Rustem, Toprak Kenan, Karagoz Ahmet, Yontar Osman Can, Ucar Melisa, Kokcu Halil Ibrahim, Ozturk Berkant, Kaya Enes, Yilmaz Mustafa, Öz Ersoy
Department of Cardiology, Faculty of Medicine, Samsun University, Samsun 33805, Turkey.
Department of Cardiology, Faculty of Medicine, Harran University, Şanlıurfa 63050, Turkey.
Medicina (Kaunas). 2025 May 4;61(5):846. doi: 10.3390/medicina61050846.
: Acute coronary syndrome (ACS) is a life-threatening cardiovascular condition with high mortality rates, necessitating accurate and early risk assessment to optimize patient outcomes. While traditional lipid markers, such as low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), are widely used, non-traditional lipid indices, including the lipoprotein combined index (LCI), atherogenic index of plasma (AIP), atherogenic index (AI), Castelli risk indices (CRI-I, CRI-II), and atherogenic combined index (ACI) may offer additional prognostic insights by reflecting the underlying atherogenic and inflammatory processes. This study aimed to assess the prognostic value of these non-traditional lipid indices, along with traditional lipid and biochemical markers, for in-hospital mortality in ACS patients. : This retrospective observational study analyzed data from ACS patients admitted to the coronary care unit (CCU) between January 2019 and September 2024. A cohort of 920 patients was divided into survivor (n = 823, 89.46%) and non-survivor (n = 97, 10.54%) groups based on in-hospital mortality outcomes. Demographic, hematological, biochemical, and lipid profile data, including traditional and non-traditional lipid indices, were collected. Separate logistic regression models were developed for each index, adjusting for demographic and clinical variables in order to assess the independent predictive power of each non-traditional lipid index. : Significant differences were observed between survivor and non-survivor groups in terms of age, c-reactive protein (CRP), white blood cell count (WBC), hemoglobin (HGB), and creatinine levels (all -values < 0.05). While traditional lipid markers, such as LDL-C and HDL-C, showed limited predictive value, non-traditional lipid indices demonstrated stronger associations. The highest Exp (Beta) values were observed for the CRI-II, AI, and CRI-I. An ROC analysis further confirmed that the CRI-II, AI, and CRI-I had the highest AUC values, with pairwise comparisons underscoring the CRI-II's superior accuracy. These findings suggest that non-traditional lipid indices predict atherogenic risk better than traditional markers alone. : Non-traditional lipid indices, particularly the CRI-I and II, AI, LCI, ACI, and AIP, were found to be significantly associated with in-hospital mortality in ACS patients. These indices may provide additional prognostic value beyond traditional lipid parameters; however, further prospective studies are needed to confirm their clinical utility. These results underscore the importance of integrating non-traditional lipid indices into routine risk assessments to improve mortality predictions and inform targeted interventions in high-risk ACS patients.
急性冠状动脉综合征（ACS）是一种危及生命的心血管疾病，死亡率很高，因此需要进行准确的早期风险评估以优化患者预后。虽然传统的血脂指标，如低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）被广泛使用，但非传统的血脂指标，包括脂蛋白综合指数（LCI）、血浆致动脉粥样硬化指数（AIP）、致动脉粥样硬化指数（AI）、卡斯泰利风险指数（CRI-I、CRI-II）和致动脉粥样硬化综合指数（ACI），可能通过反映潜在的动脉粥样硬化和炎症过程提供额外的预后信息。本研究旨在评估这些非传统血脂指标以及传统血脂和生化标志物对ACS患者院内死亡率的预后价值。
这项回顾性观察性研究分析了2019年1月至2024年9月期间入住冠心病监护病房（CCU）的ACS患者的数据。根据院内死亡结局，将920例患者分为存活组（n = 823，89.46%）和非存活组（n = 97，10.54%）。收集了人口统计学、血液学、生化和血脂谱数据，包括传统和非传统血脂指标。为每个指标建立了单独的逻辑回归模型，并对人口统计学和临床变量进行了调整，以评估每个非传统血脂指标的独立预测能力。
存活组和非存活组在年龄、C反应蛋白（CRP）、白细胞计数（WBC）、血红蛋白（HGB）和肌酐水平方面存在显著差异（所有P值<0.05）。虽然传统的血脂指标，如LDL-C和HDL-C，显示出有限的预测价值，但非传统血脂指标显示出更强的相关性。CRI-II、AI和CRI-I的Exp（Beta）值最高。ROC分析进一步证实，CRI-II、AI和CRI-I的AUC值最高，两两比较突出了CRI-II的更高准确性。这些发现表明，非传统血脂指标比单独的传统标志物更能预测动脉粥样硬化风险。
发现非传统血脂指标，特别是CRI-I和II、AI、LCI、ACI和AIP，与ACS患者的院内死亡率显著相关。这些指标可能提供超出传统血脂参数的额外预后价值；然而，需要进一步的前瞻性研究来证实它们的临床效用。这些结果强调了将非传统血脂指标纳入常规风险评估以改善死亡率预测并为高危ACS患者的靶向干预提供信息的重要性。
