| Background:Significant coronary artery disease was defined as stenosis>70%of the diameter of at least one of the major epicardial(left anterior descending,left circumflex or right coronary artery)or branch vessel that was more than 2mm in diameter or stenosis ? 50%of the diameter of the main left coronary artery.This type of coronary artery lesion results in the reduction of the coronary blood flow reserve function,which will decrease the patients' activity tolerance and obviously influence their quality of life.On the other hand,the vulnerable atherosclerotic plaque disruption will be followed by acute coronary thrombus formation,leading to acute myocardial infarction and lifetime reduction.Therefore,its early detection and treatment is important.The common mean for diagnosis of coronary artery disease is an invasive testing,namely,coronary angiography,which used to be the golden standard and may be accompanied by some potential complications including hematoma formation at site of puncture,vital organ embolism by the plaque coming off from the vessel wall through the catheter path,coronary artery dissection,and so on.And there was a study demonstrating that patients with the positive result of the noninvasive testing such as resting electrocardiography,exercise stress tests,echocardiography,computed tomography scan,had 41%of significant coronary artery disease.It's necessary to screen patients before cardiac catheterization with efficient non-invasive tests so that improves the diagnostic ratio of significant coronary artery disease.Studies have demonstrated that cystatin C maybe correlated with the pathogenesis of coronary artery disease and carotid artery atherosclerotic plaque is a manifestation of system atherosclerosis.Both of them can predict coronary and its extent,severity and complexity.However,there is no study combining cystatin C with carotid artery disease to predict coronary artery disease.Considering the value of carotid artery plaque score for predicting coronary artery disease is more precise than intima-media thickness,we assessed the efficacy of carotid artery plaque score with cystatin C for predicting the present of significant coronary artery disease in patients with chest pain.Method:According to the criteria of selection,a total of 192 patients from October,2014 to June,2016 in Zhujiang Hospital of Southern Medical University with chest pain were involved retrospectively.On the basis of the coronary angiography results,the patients were divided into groups of significant coronary artery disease(128 patients)and non-significant coronary artery disease(64 patients).Results:The basic clinical data suggested that the group of significant coronary artery disease compared to non-significant coronary artery disease,the ratio of male(78.9%:48.4%,P = 0.000),the ratio of smoking(52.3%:20.3%,P = 0.000),the plasma level of cystatin C[1.07(0.93-1.23):0.96(0.81-1.10)(mg/L),P = 0.000]and the carotid artery plaque score[5.50(2.63-9.00):2.95(0.00-5.55)(mm),P = 0.000]were significantly higher.And the left ventricular ejection fraction[LVEF,50%(53.13%-60.00%):60%(46.15%-60.00%),P = 0.000]was significantly lower.Spearman rank correlation analysis showed that both cystatin C and carotid artery plaque score were correlated with significant coronary artery disease(r = 0.252,P =0.000 and r = 0.308,P = 0.000,rescpectively).After partial correlation analysis,both of them were still correlated with significant coronary artery disease(r = 0.169,P =0.020 and r = 0.229,P = 0.001).Logistic regression analysis demonstrated that cystatin C and carotid artery plaque score were independent predictors of significant coronary artery disease.And the unadjusted odds ratios(OR)associated with cystatin C(each lmg/L)and the carotid artery plaque score(each 1mm)for prediction of significant coronary artery disease were 1.329(95%CI:1.140-1.550,P=0.000)and 1.197(95%CI:1.095-1.308,P = 0.000),respectively.After adjustment,the OR were 1.219(95%CI:1.023-1.454,P= 0.027),1.180(95%CI:1.063-1.309,P = 0.027),respectively.Receiver operating characteristic(ROC)curve analysis showed that the areas under the curves(AUC)for the the cystatin C and carotid artery plaque score to predict the significant coronary artery disease were 0.654(95%CI:0.572-0.736,P = 0.000),0.688(95%CI:0.611-0.765,P = 0.000),respectively.And the combination of cystatin C and carotid artery plaque score increased the AUC to 0.742(95%CI:0.668-0.817,P = 0.000).The optimal cut-off level of Cystatin C was 0.95mg/L and had 72.3%sensitivity for SCAD.Similarly,the optimal cut-off value of the carotid artery plaque score was 3mm which presented a sensitivity of 70.7%.A Cystatin C ? 0.95mg/L and a carotid artery plaque score ? 3mm had negative predictive values of 46.3%and 48.3%,respectively,for significant coronary artery disease.Combining the cystatin C and carotid artery plaque score,the sensitivity and negative predictive value increased to 83.6%and 62.5%,respectively.Conclusions:Cystatin C and carotid artery plaque score are both positively correlated with significant coronary artery disease,and are independent predictive factors for significant coronary artery disease in patients with chest pain.Combination of cystatin C and carotid artery plaque score can improve the predictability,which will increase the reliability of screening significant coronary artery disease before cardiac catheterization. |
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