Correlation Between Atherogenic Index Of Plasma (AIP) And Severity Of Coronary Artery Disease In Patients With Premature Acute Coronary Syndrome

ObjectiveTo compare the predictive value of lipid indexes for premature acute coronary syndrome(ACS),and to evaluate the feasibility of AIP in predicting premature ACS.At the same time,the correlation between AIP and the severity of coronary artery disease in this group was determined,which provided the evidence for predicting and diagnosing premature ACS and choosing reasonable prevention and treatment plan.MethodsA total of 396 patients with suspected ACS who were admitted to the Yangzhou Subei Hospital and underwent coronary angiography were collected.There were three groups.The premature ACS group with a total of 151 patients of whom male<55 and female<65.The mature ACS group with a total of 134 patients of whom male≥55 and female≥65.The normal control group with 111 patients who’s coronary angiography was normal.The patients in the premature ACS group were graded by the Gensini score according to the coronary artery lesion segment and stenosis degree,and then divided into 2 subgroups according to the score results.The low-risk group with 92 patients of whom Gensini score≤40.The middle-high-risk group with 59 patients of whom Gensini score>40.The general data of all the selected subjects were collected and the lipid levels were measured.AIP values were calculated according to the formula AIP=log10(TG/HDL-C).Results1.Comparison of three groups of basic clinical features and laboratory data.Compared with the normal control group,the male rate,smoking rate,drinking rate,the prevalence of diabetes,BMI,the levels of WBC,PLT and UA of the premature ACS group were significantly increased(p<0.05);the age,male rate,smoking rate,the prevalence of hypertension,the prevalence of diabetes,the levels of WBC and UA were significantly increased in the mature ACS group(P<0.05);compared with the mature ACS group,the age of premature ACS group were significantly decreased(p<0.05),the BMI,the levels of PLT of premature ACS group were significantly increased(p<0.05).2.Comparison of three groups of lipid parameters and AIP.Compared with the normal control group,the levels of TG,TC,LDL-C,apoB and AIP of ACS group were significantly increased(p<0.05),the levels of HDL-C,apoAl of premature ACS group were significantly decreased(p<0.05);the levels of AIP of mature ACS group were significantly increased(p<0.05),the levels of HDL-C,apoAl of mature ACS group were significantly decreased(p<0.05);compared with the mature ACS group,the levels of TG_TC、LDL-C、apoB and AIP of premature ACS group were significantly increased(p<0.05),the levels of HDL-C,apoAl of premature ACS group were significantly decreased(p<0.05).3.Multivariate Logistic regression analyses for lipid parameters and AIP.After adjusted,TG,TC,HDL-C、LDL-C,Lp(α),apoB and AIP are independent predictors of premature ACS.AIP was more dangerous to premature ACS than other traditional lipid parameters(x2-df=10.322,95%CI:2.946～60.010,P =0.001).4.ROC curve of the predictive value of AIP in premature ACS and ACSThe critical value of AIP diagnosis of premature ACS was 0.18,the area under the ROC curve was 0.764(95%CI:0.705～0.823,P<0.001),the sensitivity was 73.5%and the specificity was 73.9%.The critical value of AIP diagnosis of ACS was 0.15,the area under the ROC curve was 0.675(95%CI:0.618～0.733,P<0.001),the sensitivity was 61.4%and the specificity was72.1%.5.Comparison of three groups of coronary artery disease characteristics.There was significant difference in the number of coronary artery lesions in the premature and mature ACS group(P<0.05).Compared with the mature ACS group,the premature ACS group had a high proportion of single branch lesions and a low proportion of double branch and multiple branch lesions.For the location of coronary artery disease,the premature ACS group had a low proportion of patients with left anterior descending branch lesion compared with the mature ACS group(P<0.05).The average value of the Gensini score in three groups was not completely equal,the difference was statistically significant(P<0.05).Comparison among groups,the average Gensini score of the normal control control group was lower than that of the premature and mature ACS group(P<0.05),and there was no significant difference of Gensini score between premature and mature ACS group(P>0.05).6.Comparison of lipid parameters and AIP in each subgroup of premature ACS group.Compared with the low-risk group,the levels of LDL-C and apoB of middle-high risk group were significantly increased(p<0.05),the levels of HDL-C,apoA1 of middle-high risk group were significantly decreased(p<0.05).7.Correlation analysis between Lipid parameters include AIP and Gensini Score ApoB,AIP were positively correlated with the Gensini score,and the correlation coefficients and P were(r=0.162,P=0.047;r=0.170,P=0.037);HDLC,apoA1 were negatively correlated with Gensini score,and the correlation coefficients and P were(r=-0.227,P=0.005;r=-0.254,P=0.002).ConclusionWith the exception of apoAl,the other traditional lipid parameters and AIP are independent predictors of premature ACS,AIP is more dangerous than other traditional lipid parameters and is a more powerful predictor of premature ACS.A great majority of premature ACS are single vascular lesions,and regardless of the age at which the ACS occurs,LAD is the main lesion.At the same time,there was no significant difference in coronary severity between premature and mature ACS patients.The decrease of cardiovascular protective factors of HDL-C and apoAl levels have a more significant correlation for the severity of coronary artery disease in premature ACS patients.Although AIP has a certain correlation with this severity,the degree of correlation is relatively weak.To sum up,the AIP calculation is simple and easy to be widely used in clinical practice,and can be used as a reliable index for clinical prediction and diagnosis of premature ACS.AIP is also associated with the severity of coronary artery disease in patients with premature ACS,it has relatively high clinical significance.The current research on the relationship between AIP and premature ACS can provide a new perspective and direction for the prevention and treatment of diseases in the future.Increasing sample size,multi-index combined analysing and diagnosing,and prospective studies and follow-up of coronary artery disease severity may lead to better results.