| Objective: To investigate whether the combination of ankle brachial index (ABI) and serum high sensitivity C-reactive protein (hs-CRP) can improve their diagnosis value for the extent of coronary artery disease (CAD) in patients.Methods: The study population consisted of 120 patients scheduled to undergo elective cardiac catheterization for suspected coronary artery disease (during September 2010 and December 2010) at the Department of Cardiology, the Second Affiliated Hospital of Dalian Medical University. The baseline clinical data were collected including age, sex, smoking history, history of hypertension, diabetes history, records of drugs used, fasting blood glucose (FPG), triglyceride (TG), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), blood urea nitrogen (BUN), creatinine (CER) and hs-CRP before undergoing coronary angiography. Standard desktop mercury sphygmomanometer was used for the determination of bilateral brachial artery systolic blood pressure and ankle artery systolic blood pressure (the average of three unilateral foot dorsum artery systolic blood pressure). The bilateral ABI of each patient needed to be calculated, and the low-value was taken as the patients' ABI. Cardiac catheterization was performed via the femoral or radial artery and coronary angiograms were obtained from all patients. The detailed results were recorded to calculate the Gensini score and the number of coronary artery disease, meanwhile the severity of CHD (coronary heart disease) was assessed according to the clinical manifestations of patients. According to the degree of coronary stenosis, Gensini score, the number of coronary artery stenosis and the severity of CHD all subjects were divided into different groups. By analyzing the association between ABI, hs-CRP and Gensini score, the number of coronary vessel disease, we tried to evaluate the diagnostic value of ABI and hs-CRP in patient with coronary artery disease. Then the diagnostic value of ABI, hs-CRP and the combination of ABI and hs-CRP were analyzed to investigate whether the predicting value could be improved. All analyses were performed with use of SPSS version 17.0. A P value of less than 0.05 was considered statistically significant.Results: 1.1 According to the results of coronary angiography, all cases were divided into three groups: non-atherosclerosis group, coronary artery stenosis≤50% group and coronary artery stenosis >50% group: ABI in coronary artery stenosis >50% group was lower than that in non-atherosclerosis group (P<0.05), hs-CRP was higher than that in non-atherosclerosis group (P<0.05); hs-CRP in coronary artery stenosis >50% group was higher than that in coronary artery stenosis≤50% group (P<0.05).1.2 According to Gensini score, all subjects were divided into two groups: non-serious CAD group (Gensini score≤30) and severe CAD group (Gensini score >30). ABI in severe CAD group was lower than that in non-severe CAD (0.90±0.20 vs 1.06±0.13, t=2.323, P<0.05); hs-CRP was significantly higher than that in non-serious CAD group (9.40±6.65 vs 1.34±1.56, t=-4.554, P<0.01).1.3 According to the results of coronary angiography, the patients with coronary artery disease (artery stenosis >50%) were divided into three groups: single-vessel CAD group, double-vessel CAD group and multi-vessel CAD group. With the number of coronary vessel disease increasing, ABI was significantly decreased, and hs-CRP showed a clear upward trend: ABI in multi-vessel CAD group was lower than that in single vessel CAD group (P<0.01), hs-CRP was higher (P<0.01); ABI was lower (P<0.05) and hs-CRP was higher (P<0.05) in multi-vessel CAD group than that in two-vessel CAD group.2.According to the clinical manifestations of patients, all cases were divided into four groups: acute myocardial infarction (AMI) group, unstable angina pectoris (UAP) group, stable angina pectoris (SAP) group and control group, ABI of CHD group was lower than that in the control group, hs-CRP showed higher, and with the severity of disease increasing, ABI was gradually reduced, hs-CRP was gradually increased: compared with the control group, ABI in patients with AMI and UAP was lower (P<0.05), hs-CRP was higher (P<0.01); compared with the SAP group, hs-CRP was also higher in UAP group (P<0.05).3.The correlation analysis shows: ABI was negatively correlated with Gensini score which could reflect coronary artery stenosis (r=-0.553, P=0.002), hs-CRP with Gensini score showed a significantly positive correlation (r=-0.628, P=0.001). The correlation between ABI and the number of coronary vessel disease was significantly negative (r=-0.604, P=0.002), hs-CRP with the number of coronary vessel disease showed a significantly positive correlation (r=0.521, P=0.009).4.With ABI <0.9 and hs-CRP >3 (mg/L) as the cutoff value, combining the two methods to predict serious stenosis and multi-vessel CAD, the sensitivity was respectively 85%, 92%, and the specificity was respectively 69%, 61%. Compared with using ABI or hs-CRP alone, the sensitivity of the two joint detection for predicting CAD increased significantly (P<0.05); the specificity decreased, but the difference between them was not statistically significant.Conclusion: 1.ABI and hs-CRP are closely related with the extent of coronary artery disease, and their diagnostic value for serious stenosis and multi-vessel CAD is better. To identify high-risk patients with coronary heart disease, ABI and hs-CRP have important clinical significance.2.The combination of ABI and hs-CRP may have higher practical value for predicting the severity of coronary artery disease. |
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