Predictive value of serum YKL-40 and neutrophil/lymphocyte ratio for the severity of coronary artery disease in patients with acute ST-segment elevation myocardial infarction

Fang, Caoyang; Chen, Zhenfei; Pan, Jianyuan; Zhang, Jing; Jin, Xiaoqin; Yang, Mengsi; Huang, Luyao

doi:10.21203/rs.3.rs-1600452/v1

Cited by 2 publications

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“…Серцево-судинні захворювання є основною причиною смертності та факторів інвалідності, що було прогнозовано ще в 1996 році згідно з дослідженням GBD -Global Burden of Disease, в якому тенденції захворюваності та смертності 1990 року були використані для прогнозування на 2020 рік [1]. Гострий інфаркт міокарда (ІМ) та раптова серцева смерть є основними причинами смертності при ішемічній хворобі серця (ІХС) [ [8][9][10]. Існують публікації, в яких вивчався вплив інфаркт-залежної судини на віддалені наслідки інфаркту та виявлено більш важкі наслідки при ураженні лівої коронарної артерії [11,12].…”

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Clinical Consequences Dependence of Acute Coronary Syndrome Invasive Treatment on the Characteristics of Segmental Injury of Coronary Arteries

Maslii¹,

Dzubanovsky

2023

Scientific and practical journal

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Cardiovascular diseases are the main cause of mortality and disability factors. Prediction of the possible consequences of treatment, based on data on the features of anatomical localization of lesions, will obviously be able to improve the quality of treatment and reduce the level of disability. Optimization of interventional treatment methods depending on the coronary vasculature anatomical features, the development of collateral blood flow is aimed at the implementation of a personalized approach to the medical care.The aim of the work was to optimize interventional treatment of patients with acute coronary syndrome by studying the features of segmental formation of coronary arteries. The study analyzed the data of 121 patients with acute coronary syndrome who underwent coronary angiography with radial access and stenting of the infarct-related artery. Determination of coronary artery segments was performed according to the numbering method proposed by the American Heart Association. The severity of coronary artery disease was determined according to the Gensini scale. 88.43% of the patients included in the study had multivessel coronary disease. A relation was established between the lesion of segment 10 (r=0.312, p<0.001), segment 11 (r=0.211, p=0.015) and segment 14 (r=0.228, p=0.008) with the occurrence of MI recurrences. In case of diagonal artery lesions (D2), recurrences of MI occurred in 40.0% of patients, in the circumflex artery: 14 segment – 25.0%, and 11segment – 14.29%. In the remaining cases, the proportion of MI recurrences was significantly lower (from 2.67 to 8.86%). Analysis of the segmental localization of the infarct-related area of the coronary artery shows that there are certain "typical" areas of lesions in right and left coronary arteries - the middle section of the right coronary artery and the proximal section of the anterior interventricular branch of the left coronary artery. We also consider the obtained data to be important for predicting the risk of myocardial infarction recurrence, which turned out to be greater with occlusion of the 10th, 11th, and 14th segments of the coronary artery. In patients over 63 years of age, attention should be paid to the fourth segment of the right coronary artery, since occlusion of this section occurs more often in this age group. Atherosclerotic injury to the proximal part of the right coronary artery usually is not accompanied by prodromal syndrome of myocardial infarction in the form of unstable angina pectoris.The number of implanted stents did not reliably affect mortality and long-term survival. Correlations of lesions of certain segments of coronary vessels with previous manifestations of unstable angina pectoris and recurrent course, age and gender differences, presence of comorbidity, especially with arterial hypertension and diabetes have been established. Structural and functional changes in the myocardium were found to be the most severe in pathology of the left main stem. The relation between the lesion of the left main stem and the deterioration in the left ventricle ejection fraction (r=-0.244, p=0.005), the development of the left ventricle aneurysm (r=0.211, p=0.015) was established in 16.67% (in other segments - from 0 to 5.55%), rhythm disorders such as atrial fibrillation (r=0.304, p<0.001) in 25.00% (in other segments – from 2.17 to 9.52%), were more often accompanied by acute heart failure (Killip3-4) in 17.67% (in other segments - from 0 to 7.50%).

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Clinical Consequences Dependence of Acute Coronary Syndrome Invasive Treatment on the Characteristics of Segmental Injury of Coronary Arteries

Maslii¹,

Dzubanovsky

2023

Scientific and practical journal

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The Value of Serum YKL-40 and TNF-α in the Diagnosis of Acute ST-Segment Elevation Myocardial Infarction

Fang

Chen

Zhang

et al. 2022

Cardiology Research and Practice

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Background. Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease that poses a great threat to the life and health of patients. Therefore, early diagnosis is important for STEMI patient treatment and prognosis. The purpose of this study was to investigate the value of serum YKL-40 and TNF-α in the diagnosis of STEMI. Methods. From October 2020 to February 2022, 120 patients with STEMI were admitted to the Chest Pain Center of the Second People’s Hospital of Hefei, and 81 patients with negative coronary angiography were selected as the control group. Serum YKL-40 and TNF-α concentrations were measured by sandwich ELISA. Pearson correlation was used to analyze the correlation between serum YKL-40, TNF-α, and serum troponin I (cTnI) in STEMI patients; multivariate logistic regression analysis was used to screen independent risk factors for STEMI. Three diagnostic models were constructed: cTnI univariate model (model A), combined serum YKL-40 and TNF-α model other than cTnI (model B), and combined cTnI and serum YKL-40 and TNF-α model (model C). We assessed the clinical usefulness of the diagnostic model by comparing AUC with decision curve analysis (DCA). Results. Serum YKL-40 and TNF-α in the STEMI group were significantly higher than those in the control group ( P < 0.001 ). On Pearson correlation analysis, there was a significant positive correlation between serum YKL-40, TNF-α, and cTnI levels in STEMI patients. Multivariate logistic regression analysis showed that serum YKL-40 and TNF-α were independent risk factors for the development of STEMI. The results of ROC analysis showed that the area under the curve (AUC) of serum YKL-40 for predicting the occurrence of STEMI was 0.704. The AUC of serum TNF-α for predicting the occurrence of STEMI was 0.852. The AUC of cTnI as a traditional model, model A, for predicting the occurrence of STEMI was 0.875. Model B predicted STEMI with an AUC of 0.851. The addition of serum YKL-40 and serum TNF-α to the traditional diagnostic model composed of cTnI constituted a new diagnostic model; that is, the AUC of model C for predicting the occurrence of STEMI was 0.930. Model C had a better net benefit between a threshold probability of 70–95% for DCA. Conclusion. In this study, we demonstrate the utility of serum YKL-40 and TNF-α as diagnostic markers for STEMI and the clinical utility of diagnostic models by combining serum YKL-40 and TNF-α with cTnI.

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Predictive value of serum YKL-40 and neutrophil/lymphocyte ratio for the severity of coronary artery disease in patients with acute ST-segment elevation myocardial infarction

Cited by 2 publications

References 0 publications

Clinical Consequences Dependence of Acute Coronary Syndrome Invasive Treatment on the Characteristics of Segmental Injury of Coronary Arteries

Clinical Consequences Dependence of Acute Coronary Syndrome Invasive Treatment on the Characteristics of Segmental Injury of Coronary Arteries

The Value of Serum YKL-40 and TNF-α in the Diagnosis of Acute ST-Segment Elevation Myocardial Infarction

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