Study On The Relationship Between The Level Of Serum Residual Lipoprotein Cholesterol And The Clinical Prognosis Of Patients With Coronary Heart Disease

Objectives:Globally,the occurrence of major adverse cardiovascular events in patients with coronary heart disease after discharge still needs to be improved.In order to reduce the incidence of adverse cardiovascular events in patients with coronary heart disease,the purpose of this study was to explore the relationship between the level of Remnant Lipoprotein Cholesterol(RLP-C)and the clinical prognosis of patients with coronary heart disease,and to establish a predictive model to improve the prognosis of patients with coronary heart disease.Methods:Patients with chest tightness and chest pain in our hospital from March 2019 to September 2019 were selected,all patients underwent coronary angiography in our hospital,and a total of 290 cases were selected.Collect patient data and serum samples.According to the previous basis of the research group,the level of serum RLP-C was detected by enzymatic method.The patients were followed up after discharge,and the end events concerned were cardiogenic death,new myocardial infarction or stroke,readmission due to heart failure or angina pectoris.The relationship between RLP-C level and adverse cardiovascular events in patients with coronary heart disease after discharge was analyzed,and survival analysis was carried out.Combined with the risk factors screened by RLP-C and LASSO regression model,the Nomogram predictive model of adverse cardiovascular events in patients with coronary heart disease after discharge was established by R language,and the model was verified and evaluated.Results:During the follow-up period of this study,a total of 70 patients had concerned end events.In the cardiovascular event group,the proportion of diabetes mellitus was higher than that in the non-cardiovascular event group,and the ratio of RLP-C and macroplatelet in the cardiovascular event group was significantly higher than that in the non-cardiovascular event group(P<0.05).General comparison showed that there was no significant difference in age,sex,history of hypertension,smoking history,BMI and whether or not receiving PCI treatment between the two groups(P>0.05).The results of other blood cell count:there was no significant difference in leukocyte count,neutrophil absolute value,lymphocyte absolute value,monocyte absolute value,hemoglobin,red blood cell,hematocrit and platelet between the two groups(P>0.05).Blood lipid items:there was no significant difference in total cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol between th e two groups(P>0.05).Biochemical items:there was no significant difference in uric acid,creatinine and total bilirubin between the two groups(P>0.05).The results of echocardiography showed that the left ventricular wall motion score was higher and the left ventricular end-systolic volume was larger in the cardiovascular event group.there was no significant difference in left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-diastolic volume and left ventricular ejection fraction between the two groups(P>0.05).Further analysis showed that the prognosis of patients with coronary heart disease with higher RLP-C was poor.Combined with the results of ROC curve,it is suggested that RLP-C has a hint value in predicting cardiovascular events.The best cut-off point is 10.15,the sensitivity is 70%,and the specificity is 53%.In addition,the area under the ROC curve of RLP-C is larger than that of TC,TG,HDL-C and LDL-C,and patients with high RLP-C levels are more likely to have cardiovascular events.Further analysis shows that the baseline level of RLP-C is of great significance in predicting cardiovascular events in patients with unstable angina pectoris.Based on the indexes selected by RLP-C and LASSO regression,the Nomogram prediction model is established and verified.The results show that the prediction ability,accuracy and clinical practicability of the model are good.Conclusions:The results of this study show that the baseline level of RLP-C is independently related to the occurrence of adverse cardiovascular events in patients with coronary heart disease after discharge,and can be used as a prognostic factor for coronary heart disease,especially in predicting adverse cardiovascular events in patients with unstable angina pectoris.The Nomogram prediction model based on RLP-C level combined with left ventricular end-systolic volume,wall motion score,history of diabetes and large platelet ratio showed good predictive ability,accuracy and clinical practicability after verification and evaluation of the model.The results show that the established Nomogram prediction model is a reliable tool to predict the occurrence of cardiovascular events in patients with coronary heart disease in the future,and can quickly predict the possibility of adverse cardiovascular events in patients with coronary heart disease in the future,so as to carry out corresponding intervention for patients with different prognosis and effectively improve the prognosis of patients with coronary heart disease.