Prognosis evaluation of universal acute coronary syndrome: the interplay between SYNTAX score and ApoB/ApoA1

Abstract

Background: Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. SYNTAX and SYNTAX II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/ apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNT AX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method: Three hundred ninety-six patients with ACS undergoing percutaneous coronary intervention(PCI)and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results: ① Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium/ high risk group (p = 0.011). Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group (p = 0.032). ② Compared with SYNTAX II low-risk group, cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group (p = 0.001, p<0.001 respectively). ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group (p = 0.019, p = 0.023 respectively). ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group (p = 0.023, p = 0.044 respectively). ⑤ Logistic regression analysis showed that apoB/ apoA1 was an independent predictor of MACCE events in hospital and 5 years (p = 0.038, p = 0.016 respectively), SYNTAX score was an independent predictor of MACCE events in 1 year (medium-risk group: p = 0.02; high-risk group: p = 0.015) SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs (p = 0.003). Conclusions: ① SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.

Prognostic implications of calculated Apo‐lipoprotein B in patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcome is tied to lower cut‐points

“…Estimated Apo-B is thought to be associated with hs-CRP, microalbuminuria, Agatston calcium score 33 as well as SYNTAX score. 20 Furthermore, a robust correlation was found between Apo-B reduction and regression of atherosclerotic plaques (coronary plaque volume). 34 Accordingly, Apo-B serves as a useful biomarker providing incremental risk assessment through linking with multiple potential risk indicators.…”

“…On the other hand, there are more studies almost in concordance with our findings. [7][8][9][15][16][17][18][19][20] These studies are very heterogeneous due to different clinical contexts, population enrolled, timing of lipoprotein assays, and underlying treatment options. Most of these researches have been performed among low-risk individuals or patients with stable ischemic heart disease (SIHD) while our study is confined to STEMI.…”

Glucose induced ApoB100/ApoAI ratio changes in cultured HepG2 cells in vitro

“…2 However, numerous in vivo human cohort studies have suggested that another factor in CHD risk might be the apolipoprotein B100/ apolipoprotein AI (ApoB100/ApoAI) ratio. [3][4][5][6][7] ApoB100 is a large surface protein present on low-density lipoprotein (LDL) and serves as a ligand for the LDL receptor, which facilitates its clearance from the plasma. Apolipoprotein AI (ApoAI) is the major protein constituent on highdensity lipoprotein (HDL) and plays a central role in reverse cholesterol transport by stabilizing the HDL particle, interacting with the ATP-binding cassette transporter I, activating lecithin cholesterol acyl transferase and acting as a ligand for the hepatic scavenger receptor.…”

Glucose induced hepatic lipase expression and ApoB100/ApoAI ratio changes in cultured HepG2 cells in vitro

“…2 However, numerous studies have suggested that another factor in CHD risk might be the apolipoprotein B100/apolipoprotein AI (ApoB100/ ApoAI) ratio. [3][4][5][6][7] ApoB100 is a large surface protein present on low-density lipoprotein (LDL) and serves as a ligand for the LDL receptor, which facilitates its clearance from the plasma. Apolipoprotein AI (ApoAI) is the major protein constituent on high-density lipoprotein (HDL) and plays a central role in reverse cholesterol transport by stabilising the HDL particle, interacting with the ATP-binding cassette transporter I, activating lecithin cholesterol acyl transferase and acting as a ligand for the hepatic scavenger receptor.…”