| Background:Coronary atherosclerotic heart disease is a progressive cardiovascular disease caused by a variety of critical causes,which is mainly characterized by coronary atherosclerotic plaque formation,luminal stenosis and myocardial ischemia.Although percutaneous coronary intervention(PCI)technology has gradually matured,PCI treatment still faces more complex lesions,and coronary artery calcification(coronary artery calcification,CAC(coronary artery disease)lesions often exist in a variety of complex coronary artery diseases,which increases the difficulty of coronary intervention,the burden of treatment cost,the risk of intervention and the occurrence of adverse cardiovascular events after intervention.In recent years,a number of studies have shown that the possibility of coronary artery calcification increases with age.Among them,the high-risk group of coronary artery calcification is 60-80 years old.Therefore,most of the subjects of previous studies on coronary artery calcification are the elderly,and some studies have shown that: Young patients with high Agaston score of coronary artery calcification have a higher risk of death compared with patients over 75 years old with low Agaston score of coronary artery calcification.Therefore,early detection of coronary calcification and early prevention and intervention are of great significance to reduce the occurrence of adverse cardiovascular events in the future for young people.Many young and middle-aged patients with coronary artery calcification are also seen in clinical practice,and many of them have one or no traditional risk factor,which indicates that the occurrence of coronary artery calcification in young and middle-aged patients is not clearly related to traditional risk factors.Therefore,the high-risk population with coronary artery calcification in young and middle-aged patients should be screened as soon as possible.More young and middle-aged people should have a positive attitude to manage their bad habits and reduce risk factors,so as to reduce the incidence of coronary artery calcification and adverse cardiovascular events in young and middle-aged people.Objective:Coronary computed tomography(CT)is the gold standard for the diagnosis of coronary artery calcification,but it is unable to determine the shape and arc of coronary artery calcification.In addition,the presence of coronary artery calcification significantly increases the difficulty of coronary intervention,and increases the risk during the operation and the incidence of subsequent cardiovascular events.Therefore,to study the occurrence and development of coronary artery calcification and risk factors,Early intervention and control of risk factors can reduce the occurrence and development of coronary artery calcification,which is of great significance in the prevention and treatment of cardiovascular diseases.Therefore,this study retrospectively analyzed the formation of coronary artery calcification and the influencing factors of calcification arc(the size of coronary vessel lumen involved by coronary artery calcification lesions)in young and middle-aged patients,in order to provide early preventive measures for young and middle-aged patients,reduce the formation and progression of coronary artery calcification,reduce the occurrence of adverse cardiovascular events,and provide objective clinical basis for clinical application.Methods:A total of 341 young and middle-aged patients who met the inclusion and exclusion criteria in the Department of Cardiology of the Second Hospital of Jilin University from January 2020 to February 2022 were enrolled.Among them,49 patients underwent coronary angiography and IVUS.According to the coronary CT imaging and report,they were divided into the calcification group(n = 182)and the non-calcification group(n = 159).The calcification group was further divided into three groups according to the number of coronary calcified vessels.Patients with target lesions undergoing coronary angiography and intravenous ultrasound(IVUS)were divided into two groups according to the degree of coronary artery calcification: Ⅰ-Ⅱ degree group and Ⅲ-Ⅳ degree group.Multivariate logistic regression analysis was used to explore the factors affecting coronary artery calcification.Patients with different calcification arcs were followed up for 1 year and the data before and after were compared.(1)The general clinical data,including age,gender,history of hypertension,diabetes,drinking and smoking,were collected and compared between calcification group and non-calcification group,as well as between calcification degree Ⅰ-Ⅱ group and calcification degree Ⅲ-Ⅳ group.(2)The number of calcified coronary vessels was recorded and compared among the three groups.(3)Laboratory indexes were collected and compared between calcification group and non-calcification group,as well as between calcification radian Ⅰ-Ⅱ group and calcification radian Ⅲ-Ⅳ group.(4)Multivariate logistic regression analysis of calcification radian of coronary target lesions.(5)The laboratory indexes before and after 1 year follow-up were analyzed and compared between the Ⅰ-Ⅱ degree group and the Ⅲ-Ⅳ degree group.Results:1.A total of 341 young and middle-aged patients who met the inclusion and exclusion criteria were retrospectively analyzed.The general clinical data of the coronary calcification group and the coronary non-calcification group were compared and analyzed.Smoking history and drinking history were the same as the calcification group,accounting for 62.9% and 59.1%,respectively.The history of diabetes was still relatively large in the calcification group compared with the non-calcification group,accounting for 31.6% and 6.3%,respectively.The proportion of hypertension history in the calcification group was still higher than that in the control group.The P values of general clinical count data between the two groups were less than 0.05,indicating that there was a statistical difference between the two groups.Age and high-density lipoprotein p < 0.01 were statistically significant.2.The count data such as gender,smoking history,drinking history and measurement data such as alkaline phosphatase,triglyceride,homocysteine were included in the coronary CT calcification group and the non-calcification group.Multivariate logistic regression analysis showed that the history of hypertension,diabetes,smoking history,age increase,male,creatinine,uric acid P < 0.05,there were statistical differences.3.Ordered multivariate logistic analysis was performed on four indicators including gender,age,creatinine,and glomerular filtration rate,which had a single factor less than 0.05 between the number of calcifications in the three coronary arteries.Male and age increased p < 0.05,showing statistical differences.That is,both of them are risk factors for the increase in the number of coronary calcified vessels.4,coronary target vessel lesion calcification radian Ⅰ-Ⅱ degree group and Ⅲ-Ⅳ degree group,including the single factor affecting the coronary calcification radian p < 0.05: logistic regression analysis of age,gender,smoking history,albumin,alkaline phosphatase,creatinine and uric acid showed that age,smoking history,albumin,alkaline phosphatase and uric acid were all p < 0.05.5.Comparison of coronary artery calcification Ⅰ-Ⅱ degree follow-up data before and after 1 year showed that the homocysteine comparison was statistically significant,p < 0.05.There was no significant difference in alkaline phosphatase,creatinine,uric acid and homocysteine before and after 1 year of follow-up(p > 0.05),but the blood test values of alkaline phosphatase,creatinine,uric acid and homocysteine after 1 year of follow-up were higher than those before 1 year.6.A total of 49 patients underwent coronary angiography and intravascular ultrasound(IVUS)examination,1 case(4.35%)had severe angina symptoms,and 2 cases(8.70%)had aggravated coronary calcification arc.In group Ⅲ-Ⅳ,there were 3 cases(12.5%)of angina pectoris,1 case(4.17%)of heart failure,2 cases(8.33%)of stent restenosis,and 1 case(4.17%)of coronary calcification arc aggravation(further decrease of coronary lumen area).It further indicates that coronary artery calcification requires early prevention or correction of risk factors to curb the progression of calcification.Conclusions1.The main risk factors affecting the formation of coronary artery calcification in young and middle-aged patients are gender,age,smoking,diabetes,hypertension,and hyperuricemia.2.Age,smoking,alkaline phosphatase and uric acid are the main risk factors affecting the calcification arc of coronary target lesions.3.The predictive model of vascular calcification arc in young and middle-aged coronary target lesions: high albumin is a protective factor,while smoking,high alkaline phosphatase and high uric acid are risk factors. |
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