To Study The Correlation Between Teg Combined With Inflammatory Markers And The Severity Of Coronary Artery Disease And To Establish A Risk Prediction Model For AMI

Objective(s):To explore the correlation between coagulation and inflammation abnormalities and the severity of coronary artery disease,and to analyze the correlation with blood lipid,and to establish a risk prediction model for acute myocardial infarction.Methods:Patients diagnosed with coronary artery disease in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from February 1,2021 to September 30,2022 were selected as the case group.Coronary artery disease included coronary atherosclerosis(n=101),coronary heart disease(n=243),acute myocardial infarction(n=108),and the total number of cases in the case group was452 cases.The healthy people who visited the hospital during the same period were selected as the control group,with a total number of 57 cases.1.The following indicators of the case group at admission were retrospectively collected: 1)Coagulation indicators: TEG parameters(R,K,Angle,MA,CI),PLT?;2)Inflammatory markers: IL-6,PCT,hs-CRP,WBC?,NEUT?,LYMPH?,and MONO?;3)Blood lipid indicators: TC,TG,HDL-C,LDL-C,NONHDL-C,Lp(a),APOA1,APOB;4)Other related indicators: HB,HCY,c IMT;5)Coronary angiography results and risk factors related to coronary artery lesions.At the same time,the corresponding coagulation,inflammation and blood lipid indexes of the control group were collected,and the Gensini score was used to quantify the severity of coronary artery disease according to the results of coronary angiography in the case group.2.Analyze the differences of indicators between the control group and the case group;The correlation between Gensini score and the above measurement data in the case group and the difference of Gensini score between the categorical variables were analyzed.The correlation between TEG parameters and inflammatory indicators,and blood lipid indicators in the case group,and the correlation between inflammatory indicators and blood lipid indicators were analyzed.3.The case group was divided into AMI group and non-AMI group.The modified Poisson regression analysis was performed with AMI as the dependent variable,variables related to Gensini score in correlation analysis,and indicators with statistically significant Gensini score between groups in categorical variables as independent variables,and stepwise regression method was used to establish the model.Model 1 included: coagulation and lipid related indicators;Model 2 included: Model 1+ inflammation-related indicators;Model 3 included:model 2+HCY+c IMT;Model 4 included: model 3+ CHD risk factors(such as gender,age,BMI,hypertension,diabetes,smoking,drinking,etc.).Results:The results of data comparison between the control group and the case group showed that there were significant differences in all parameters of TEG between the case group and the control group.The differences in inflammatory markers were statistically significant except LYMPH?.Only HDL-C was significantly different from APOA1(p < 0.05),and there was no significant difference in other indicators.Correlation analysis of coronary artery disease in case group: 1.Correlation analysis results showed that TEG parameter K was negatively correlated with Gensini score(p < 0.05),parameters Angle,MA,CI were positively correlated with Gensini score(p < 0.01),parameter R was not correlated with Gensini score.All inflammatory markers except LYMPH? were positively correlated with Gensini score(p < 0.01).HDL-C and APOA1 were negatively correlated with Gensini score(p < 0.01),and the rest were not correlated with Gensini score.HCY and c IMT were positively correlated with Gensini score(p < 0.01).There were significant differences in Gensini scores between male and female,diabetes mellitus group and non-diabetes mellitus group,smoking group and non-smoking group,hypertension group and non-hypertension group.Age,BMI,PLT?,and HB were not correlated with Gensini score.In addition,TEG parameters MA,inflammatory markers(IL-6,hs-CRP,M0NO?),HCY and c IMT-X were independently associated with Gensini score(p < 0.001),while hypertension(p < 0.05)and diabetes(p < 0.01)were independently associated with Gensini score.2.The results of correlation analysis between TEG parameters and inflammatory indicators showed that the TEG parameter MA was positively correlated with all inflammatory indicators except PCT,and the parameters of TEG were not correlated with PCT.3.The results of correlation analysis between TEG parameters and blood lipid indexes showed that the TEG parameter MA was positively correlated with TC,TG,LDL-C,NONHDL-C and APOB,and the other parameters were not correlated with the blood lipid indexes.4.The results of correlation analysis between inflammatory indexes and blood lipid indexes showed that all inflammatory indexes were negatively correlated with HDL-C;Except PCT and LYMPH?,all inflammatory markers were negatively correlated with APOA1(p <0.01).Modified Poisson regression analysis: 1.The results of model 1 showed that TEG parameter MA and blood lipid index APOA1 were predictors of AMI risk,and MA was an independent predictor of AMI risk.The regression equation was: Ln(Y)=-0.857+0.014×MA-0.563×APOA1.2.The results of model 2 showed that TEG parameter CI,inflammatory markers(IL-6,NEUT?)and blood lipid marker APOA1 were predictors of AMI risk,and the regression equation was constructed as follows:Ln(Y)=-0.111-0.069×CI + 0.01 ×(IL-6)+ 0.049 × NEUT ?-0.373 ×APOA1.3.The results of model 3 showed that TEG parameter CI,inflammatory markers(IL-6,NEUT?)and blood lipid marker APOA1 were predictors of AMI risk,and the regression equation was constructed as follows: Ln(Y)= 0.135-0.074 × CI + 0.02×(IL-6)+ 0.041 ×NEUT ?-0.355 × APOA1.4.The results of the model showed that the risk of AMI increased by 0.074 times when the TEG parameter CI decreased by 1unit,which was statistically significant(RR=0.926,95%CI0.867-0.989,p=0.022).The risk of AMI increased by 0.019 times(RR=1.019,95%CI1.010-1.029,p < 0.001)and 0.044 times(RR=1.044,95%CI1.010-1.080,p=0.012)for each unit increase in inflammatory markers(IL-6 and NEUT?),respectively.Statistically significant;The risk of AMI increased by 0.265 times when APOA1 decreased by 1 unit(RR=0.735,95%CI0.597-0.905,p=0.004).Finally,the regression equation was constructed as Ln(Y)=0.007-0.077×CI+0.019×(IL-6)+0.043×NEUT?-0.308×APOA1.Conclusion(s):1,Hypercoagulable state due to high fibrinogen(decreased K/increased Angle),platelet(increased MA)levels and function(increased CI),and high inflammation levels were associated with the severity of coronary lesions.The levels of HDL-C and APOA1 were negatively correlated with the severity of coronary artery disease and inflammation,while other blood lipid indexes were not correlated with the severity of coronary artery disease.2.Hypertension,diabetes and smoking are related to the severity of coronary artery disease,and the elevated c IMT and HCY levels are independent risk factors for coronary artery disease.The severity of coronary artery lesions was higher in men than in women,while age,BMI,coagulation factor activity(R),PLT? and HB were not associated with the severity of coronary artery lesions in patients.3.The level and function of platelet(MA)are positively correlated with the severity of coronary artery disease,inflammation and blood lipid,and the abnormal changes of coagulation,inflammation and blood lipid may aggravate the severity of coronary artery disease through platelet interaction.However,there is no correlation between PLT? and the severity of coronary artery disease.4,Regression model 1 showed that the TEG parameter MA was an independent predictor of AMI risk,but it was no longer significant when inflammation-related variables were added.Regression models 2,3,and 4 all showed that decreased TEG parameter CI,increased levels of inflammatory markers IL-6 and NEUT?,and decreased levels of lipid markers HDL-C and APOA1 increased the risk of AMI,and IL-6 was an independent predictor of AMI risk.Finally,for patients with coronary artery disease,the regression equation of AMI risk prediction model constructed in this study was: Ln(Y)=0.007-0.077×CI+0.019×(IL-6)+0.043×NEUT?-0.308×APOA1.