Lipid Profile Analysis Of Patients With Acute Coronary Syndrome In CCU And Its Relationship With Myocardial Perfusion After Percutaneous Coronary Intervention

Objective:Observed the lipid profiles in patients with coronary artery disease, CCU patients with acute coronary syndrome by NCEP / ATP III structure in single clinic center, and to investigate the relationship of patients with acute coronary syndrome the level myocardial perfusion after coronary intervention level in cardiac care unit.Method:A total of 2397 consecutive patients admitted in Shanghai Renji Eastern Hospital, deapartment of Cardiology with coronary heart disease and with acute coronary syndrome in CCU, from April 1, 2012 to November 31, 2012. Investigate the initial hospitalizational lipid profile levels. Observations : 1) blood test indicators: the next morning after admission, fasting blood lipid parameters were measured, including triglycerides, total cholesterol, high density lipoprotein, low density lipoprotein, high density lipoprotein, low density lipoprotein, triglycerides total cholesterol,apolipoprotein A, apolipoprotein B, lipoprotein a, non-high-density lipoprotein; high-sensitivity C-reactive protein, fasting glucose, creatinine, brain natriuretic peptide. 2) history of information : name, gender, age, diagnosis, previous history of taking statins, hypertension, diabetes, history of stroke, smoking history, history of chronic renal insufficiency and so on. Statistical analysis was peformed using statistical software SPSS 16.0 on the lipid profile of ACS patients and CHD patients, and the relationship between the level of myocardial perfusion after PCI and the dyslipidemia.Results:In 2397 hospitalized patients, women 38.4%, men 62.6%.Women ocupied 1/3 of the total admission CHD patients 920( 38.4%) persons accounted for admission to 2/ 5. The total lipid levels according to the NCEP / ATP Ⅲ definition : in beyond optimal level of LDL(2.64 ± 0.90 mmol / L), HDL l:(1.25 ± 0.33 mmol / L) at the bordline level, TG(1.51 ± 0.90 mmol /L) at a normal level, TC(4.41 ± 1.05 mmol / L) at the desired level. According to the definition of the distribution of NCEP / ATP Ⅲ of all hospitalized patients, 47.4 % of patients in the high value of LDL, 34.2% of patients in the low HDL, 10.6% TG in patients with high, 5.1 % of patients in the high TC, and in patients with coronary heart disease 49.5% of patients in beyond optimal and high of LDL, 34.2% of patients in the low HDL, 12.3% TG in patients with high, 5.5% of patients in the high TC.Coronary heart disease,compared with the overall high lipid levels in the overall trend. 91% of the patients from the age of > 50 years of age constitute,the largest group of which comes from the 60 to 69 years, and > 80 years followed. TG, TC, LDL showed a gradual upward trend in the 40 to 49 age group, and 50 to 59 age group reached a higher peak, then gradually declined. There are significant differences between males and females lipids, in all atherigenic lipid(TC, TG, HDL, LDL)females are higher than males. For female patients, the incidence of CHD(26.5%) less than the incidence of males( 45.6%).In the present study, there are 371 males(77.0%), 111 women(23%) ICU patients with ACS, a higher proportion of males compared to patients with CHD; the proportion of unstable angina(6.4%), acute ST segment elevation myocardial infarction(52.5%), non-ST-segment elevation myocardial infarction(41.1%).According to NCEP / ATP III definition, lipid levels in LDL levels 2.75 ± 0.87 mmol / L, over the optimal value. Compared with CHD, low HDL and high TG proportion increased. One way ANOVA showed that Apo B(P = 0.039), LDL(P = 0.046), Apo B / Apo A ratio(P = 0.015) were significantly different among STEMI, NSTEMI, UAP group; Multiple stepwise Logistic regression analysis showed that :(1)In ACS patients,the LDL, Apo B levels was negatively correlated with statins intake history, women, diabetes and age,while the coronary arteries were positively correlated. There was no significant between ACS patients with hypertension. compared diabetic patients(2.59 ± 0.81 mmol /L) with non-diabetic patients(2.80 ± 0.89 mmol / L), lower LDL in diabetic patients. Smokers has higher TG level than non-smoking patients, lower Apo A levels and HDL levels than non-smoking patients, showing the impact of smoking on dyslipidemia. There are also significant differences between males and females ACS group lipid profile, TC, LDL levels higher in women than men. Compared with stable angina pectoris(Stable angina pectoris, SAP),no differences among women; while among men TC, LCL levels significantly higher in the ACS group, HDL is lower in the ACS group. Further investigate the situation and lipid profile in patients with ACS after PCI myocardial perfusion relationships. Dyslipidemia niether in ST-segment elevation ACS nor in non- ST-segment elevation ACS patients, was not the independent predictors of myocardial perfusion after PCI.Conclusion:(1) The group of the lipid profile in patients with coronary heart disease according to NCEP / ATPIII composition: low-density lipoprotein in beyond optimal levels(2.64 ± 0.92 mmol / L), HDL l:(1.25 ± 0.33 mmol / L) at the bordline level, TG(1.51 ± 0.90 mmol / L) at a normal level, TC(4.41 ± 1.05 mmol / L) at the desired level.(2) Cardiac Care Unit LDL lipid levels in patients with ACS over optimal levels; compared with the CHD group, low HDL and high TG proportion increased. In addition to LDL, Apo B / Apo A also indicate and severity of disease between the ACS group. LDL and Apo B / Apo A are the similar factors of indicating the occurrence of disease severity. Smoking affects HDL, Apo A, TG levels, elevating TG, leaving HDL, Apo A decline; lower LDL levels in patients with diabetes; gender were significant differences between the lipids, prompt treatment for men and women had better consider gender differences.(3) Dyslipidemia is not an independent predictor of in patients with ACS after PCI myocardial perfusion levels.