Correlation Between Levels Of Plasma Glutathione Peroxidase 4 And Clinical Prognosis,risk Stratification And Prognosis Of Patients With Acute Coronary Syndrome

Objectives:To investigate the correlation between the levels of plasma glutathione peroxidase 4 and clinical characteristics,TIMI risk stratification and prognosis in patients with acute coronary syndrome.Methods:1.This study was a single-center retrospective study,in which 404 patients who underwent coronary angiography in our hospital were recruited and divided into two groups:the experimental group(ACS group,n=316)and the control group(CON group,n=88)according to their medical history,biochemical indexes,imaging results and coronary angiography results.Additionally,patients in the ACS group were subdivided into the unstable angina group(UAP group,n=261)and the acute myocardial infarction group(AMI group,n=55).Acute myocardial infarction(AMI)included acute ST-segment elevation myocardial infarction(STEMI)and acute non-ST-segment elevation myocardial infarction(NSTEMI).2.Enzyme-linked immunosorbent assay(ELISA)was used to detect plasma glutathione peroxidase 4(GPX4)levels of all recruited patients,and their various routine biochemical indexes were examined.The differences in plasma GPX4 levels among all groups were compared.Moreover,the receiver operating characteristic curve(ROC)was utilized to analyze the diagnostic value of plasma GPX4 levels for ACS and to calculate its critical value.Correlation analysis was performed using the Pearson method.Binary Logistic regression was used to assess the independent risk factors for ACS occurrence.3.The patients with ACS were stratified by TIMI Risk Score,while those with UAP/NSTEMI and STEMI were calculated according to different scoring standards.The differences in baseline data,degree of coronary lesionsplasma and GPX4 levels among patients in the high-risk group,the middle-risk group and the low-risk group of TIMI risk stratification were compared.ROC was used to analyze the diagnostic value of plasma GPX4 levels in TIMI risk stratification of ACS patients and to calculate its critical value.4.Patients with ACS discharged from the hospital were followed up at an outpatient clinic or by telephone for an average of 21 months,and the occurrence and time of MACEs events were recorded.According to whether MACEs events occurred or not,patients with ACS were divided into the MACEs group and the non-MACEs group,and the differences in plasma GPX4 levels between the two groups were compared.The MACEs events defined in this study included recurrent chest pain,heart failure,stroke,recurrent myocardial infarction,hemorrhage,revascularization,stent thrombosis,stent restenosis and death.5.Cox regression model was used to analyze the correlation between MACEs events and plasma GPX4 levels.6.According to the median plasma GPX4 level of 101.90 ng/m L in the ACS group,patients in the ACS group were subdivided into GPX4≥101.90 ng/m L group and GPX4<101.90 ng/ml group,and the Kaplan-Meier curve was drawn to observe the occurrence of MACEs events in the two groups.Results:1.The plasma GPX4 levels in the ACS group were lower than that in the control group(P<0.05).The plasma GPX4 levels were positively correlated with combined hypertension and negatively with age and SCr levels.GPX4 is an independent risk factor for ACS in patients.2.ROC showed that plasma GPX4 levels could assist the diagnosis of ACS,and the area under the curve(AUC)was 0.828(0.778-0.878),with an optimal cut-off value of 128.78 ng/m L,a specificity of 64.8%and a sensitivity of 90.0%.After the addition of two risk factors,blood creatinine and low density lipoprotein,their AUC and specificity for ACS diagnosis increased,with AUC was 0.85(0.80～0.90),a specificity of 66.3%and a sensitivity of 88.7%.3.According to TIMI risk stratification,ACS patients were divided into the high-risk group(n=36),the intermediate-risk group(n=227)and the low-risk group(n=53).In the comparison of plasma GPX4 levels between the groups,plasma GPX4 levels were elevated in the low-risk group compared with the high-risk and intermediate-risk groups(P<0.05).The Gensini score of the patients in the high-risk group was significantly higher than that in the low-risk group(P<0.05).However,there was no significant difference in plasma GPX 4 levels between the two groups.4.ROC curve showed that GPX4 levels could assist in determining whether ACS patients were at low risk in the TIMI risk stratification,and the area under the curve(AUC)was 0.665(0.577-0.754),with an optimal cut-off value of 127.06 ng/m L,a sensitivity of 37.7%,and a specificity of 95.0%(P<0.05).5.Among all patients with ACS,4 were lost to follow-up,accounting for 1.3%of the total number,and 30 had MACEs events,accounting for 9.5%of the total number.In the comparison of plasma GPX4 levels between the two groups,GPX4 levels in the MACEs group were lower than that in the non-MACEs group.6.Plasma GPX4 was included in the Cox proportional regression model for analysis,and the results showed that as plasma GPX4 levels increased in patients with ACS,the risk of MACEs events in patients with ACS decreased,indicating that elevated plasma GPX4 levels were a protective factor against MACEs events(P<0.05).The K-M curve showed that there was no significant difference in the expected survival time between ACS patients with plasma GPX4<101.90 ng/ml and those with plasma GPX4≥101.90 ng/m L(χ~2=3.70,P>0.05).Conclusion:1.Plasma GPX4 level is significantly decreased in patients with ACS,and the level was positively correlated with combined hypertension,but negatively associated with age and SCr levels.Plasma GPX4 is an independent risk factor for ACS,and GPX4 can assist the diagnosis of ACS,and has higher diagnostic value with SCr and LDL.2.Plasma GPX4 levels are significantly higher in patients in the low-risk TIMI risk stratification than in the intermediate-risk and high-risk groups,and plasma GPX4 is valuable for judging whether patients in TIMI risk stratification are in a low-risk state.3.Plasma GPX4 levels in the MACEs group are lower than those in the non-MACEs group and decreased plasma GPX4 levels are a risk factor for MACEs events.Plasma GPX4 boasts a certain reference value for the long-term prognosis of ACS.