| Objectives: To investigate the correlation between serum Lp-PLA2 and collateral circulation in patients with acute myocardial infarction(AMI)with single coronary artery occlusion,and to provide a new idea for the study of pathophysiological mechanism of collateral circulation and noninvasive detection.Methods: A total of 184 patients were included in the study.These patients were hospitalized on November 1,2019 and December 31,2020 in Huaihua Chemical Hospital of the University of South China with acute myocardial infarction(AMI)and the time window from coronary angiography to onset of AMI was less than 24 hours,of which the result was complete occlusion(100% stenosis)of one major coronary artery(right or circumflex or anterior descending).According to the results of angiography and the Rentrop classification method,the coronary collateral circulation(CCC)was rated,and the collateral circulation was grouped according to the Rentrop classification,with grades 0 and 1 being poor CCC group(n=96).Grade 2 and 3 were classified as the good CCC group(n=88),and patients with suspected chest pain symptoms of AMI and completely normal coronary angiography were selected as the control group(n=83).Preoperative Chemiluminescence(CL)was used to detect serum lipoprotein-associated phospholipase A2(Lp-PLA2)concentration levels of all patients.SPSS23.0 software package was used for statistical analysis of all data,and P < 0.05 was considered statistically significant.Results: 1.Comparison of general clinical data and biochemical data among the three groups: 1)the proportion and content of smoking history,diabetes history,hypertension history,SBP,LDL-C,CK-MB,BNP,CRP in the control group were lower than those in the poor CCC group and the good CCC group,and the differences were statistically significant(P<0.05);2)There were no significant differences in smoking history,diabetes history,hypertension history,pre-infarct angina pectoris history,SBP,CK-MB,BNP,CRP between the poor CCC group and the good CCC group(P>0.05);3)LDL-C content in poor CCC group was lower than that in good CCC group(2.71 ± 0.38 vs 2.91 ± 0.55,P<0.05),and the difference was statistically significant.2.Comparison of serum Lp-PLA2 among the three groups: 1)The serum Lp-PLA2 content in the control group was lower than that in the poor CCC group and the good CCC group(143.90±38.46 vs 196.18±21.01 vs 222.77±42.02,P<0.05),and the difference was statistically significant;2)The serum Lp-PLA2 content of CCC poor group was lower than that of CCC good group(196.18±21.01 vs 222.77±42.02,P<0.05),and the difference was statistically significant.3.Analysis of the characteristics of coronary artery lesions: there were statistically significant differences in occlusion vessels and Gensini scores between the poor CCC group and the good CCC group(P<0.05);1)RCA occlusion in the good CCC group(40.9%)was higher than that in the other two types of vascular occlusion.2)The Gensini score in good CCC group was higher than that in bad CCC group(78.59±31.80 vs 64.81±15.11,P<0.05);3)There was no significant difference in the number of disaffected vessels,occlusion location and onset time between the poor CCC group and the good CCC group(P>0.05).4.Binary logistic regression analysis of the related factors of CCC: 1)Lp-PLA2(OR 1.021,95% CI 1.009-1.033,P<0.05)and Gensini score(OR 1.006,95%CI 1.003-1.023,P<0.05)is the influencing factor of CCC formation;2)As for LDLC(OR 2.747,95%CI 0.817-5.727,P> 0.05)and occluded blood vessels(OR 2.002,95%CI 0.897-4.468,P>0.05),the difference was not statistically significant.5.Correlation analysis of serum Lp-PLA2 and CCC Rentorp grade and Gensini score: 1)The Rentorp grade of CCC increased with the increase of serum Lp-PLA2(r=0.613,P<0.05);2)The Gensini score increased with the increase of serum Lp-PLA2(r=0.0603,P<0.05).6.The ROC curve of serum Lp-PLA2 in the initial diagnosis of CCC: Serum Lp-PLA2 can be used to determine CCC in patients with single-vessel coronary artery occlusion with AMI,and the area under the ROC curve when it is used to assist in the diagnosis of CCC is 0.756(95%CI:0.687-0.816,P<0.05),when the serum Lp-PLA2 cutoff value was226ng/m L,the highest CCC determination efficiency was achieved,with a sensitivity of 65.9% and a specificity of 97.9%.Conclusions: Serum Lp-PLA2 and Gensini scores in patients with acute myocardial infarction with single-branch coronary occlusion are important influencing factors for the formation of collateral coronary circulation.The higher the serum Lp-PLA2 and Gensini scores,the better the formation of coronary collateral circulation. |
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