残余胆固醇与老年急性冠脉综合征患者的病变严重程度及预后的关联性研究

目的：探索残余胆固醇（RC）是否可成为老年冠脉综合征（ACS）患者的危险分层及预后评估指标。方法：本研究为前瞻性队列观察研究。连续入组2020年3月—2021年3月于解放军总医院心血管内科住院的老年ACS患者，通过电子病历系统收集患者的基线临床资料、实验室检查等资料并计算RC水平，通过冠脉造影的分析进行Gensini评分。对所有患者进行随访，随访终点为发生主要不良心血管事件（MACEs）。采用多因素Logistic回归模型分析发生MACEs的危险因素，受试者工作特征（ROC）曲线评估不同危险因素对ACS患者预后的预测价值，并采用Spearman相关性检验评估RC与冠脉病变严重程度的关联。结果：研究最终入选老年ACS患者740例，其中1年随访期内发生MACEs者84例（11.35%）。多因素Logistic回归分析结果显示，通过校正，LDL-c（OR=0.998,95%CI：0.997-1.000，P=0.015）与RC（OR=0.135,95%CI：0.069-0.265，P<0.001）为老年ACS发生MACEs的独立危险因素。ROC曲线分析结果显示LDL-c及RC对预后评估有良好的预测价值，AUC分别为0.754（95%CI:0.719-0.786）、0.774（95%CI:0.740-0.805），二者联合评估预后的效能优于二者单独预测0.868(95%CI:0.840-0.893)（P<0.001）。RC与Gensini评分的相关系数R2为0.49，二者呈正相关。结论：RC与老年ACS患者的冠脉病变狭窄程度正相关，并对患者MACEs的预后评估具有较好的应用价值。

Correlation between residual cholesterol and artery lesion severity and prognosis in elderly patients with acute coronary syndrome

Objective: To explore whether residual cholesterol (RC) can serve as a risk stratification and prognostic evaluation indicator for elderly patients with coronary syndrome (ACS).Method: This study was a prospective cohort observation study. Elderly ACS patients admitted to the Cardiovascular Department of Chinese PLA General Hospital from March 2020 to March 2021 were enrolled consecutively. Baseline clinical data, laboratory examination data, and other data were collected through the electronic medical record system, and RC were calculated. The Gensini score was analyzed through coronary angiography. Follow up was conducted on all patients, with the endpoint being the occurrence of major adverse cardiovascular events (MACEs). A multivariate logistic regression model was used to analyze the risk factors for the occurrence of MACEs. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of different risk factors on the prognosis of ACS patients, and the Spearman correlation test was conducted to evaluate the association between RC and the severity of coronary artery.Result: 740 elderly ACS patients were enrolled in the study, of which 84 (11.35%) had MACEs during the one-year follow-up. The results of multivariate logistic regression analysis showed that after adjustment, LDL-c (OR=0.998, 95% CI: 0.997-1.000, P =0.015) and RC (OR=0.135, 95% CI: 0.069-0.265, P<0.001) were independent risk factors for MACEs in elderly ACS. The ROC curve analysis results showed that LDL-c and RC have good predictive value for prognosis evaluation, with AUC values of 0.754 (95% CI: 0.719-0.786) and 0.774 (95% CI: 0.740-0.805), respectively. The combined evaluation of prognosis by LDL-c and RC was more efficacy than the single biomarker with 0.868 (95% CI: 0.840-0.893) (P<0.001). The correlation coefficient R2 between RC and Gensini score is 0.49, indicating a positive correlation between the RC and Gensini score.Conclusion: RC was positively correlated with the degree of coronary artery stenosis, and may be a promising biomarker for the prediction of MACEs in elderly ACS patients.