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Title: Predictive value of selected lipid parameters among patients with acute myocardial infarction


Introduction: Assessment of cardiovascular risk and its reduction are one of the main targets of primary and secondary prevention in modern non-invasive cardiology. Currently, in the available literature, besides the assessment of classical lipoproteins, some other non-classical lipid parameters have brought the attention of the researchers. Those non-classical lipid parameters are based on concentration of classical lipoproteins and calculated according to the mathematical formulas. Literature suggests an association between those non-classical lipoproteins, elevated cardiovascular risk and mortality, however the usefulness of those parameters in everyday clinical practise, especially among patients with acute myocardial infarction (AMI) remains unknown. In that research the clinical usefulness of the following non-classical lipid parameters have been evaluated - Triglyceride-Glucose Index (TyG Index), Castelli Risk Index I (CRI I), Castelli Risk Index II (CRI II), Triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C), Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC) and Lipoprotein Combine Index (LCI). Aim: The aim of the study was to assess the association between the mentioned above nonclassical lipid parameters and the occurrence of major adverse cardiovascular events (MACE) in 1-year follow-up. MACE was a composi ; te of myocardial infarction, in-stent restenosis, unstable angina, stroke or transient ischemic attack and hospitalization due to heart failure. The all-cause 1-year mortality was also evaluated. Material and methods: Patients admitted to the Department of Coronary Disease and Heart Failure of the John Paul II Hospital in Krakow due to AMI between 2013 and 2020 were enrolled to the study. The general inclusion criteria were: diagnosis of STEMI (ST-segment elevation myocardial infarction) or NSTEMI (non-ST-segment elevation myocardial infarction), coronary angiography undergone on admission with the presence of hemodynamically relevant atherosclerosis and full medical documentation. Exclusion criteria were AMI with non-obstructive CAD. Moreover, additional inclusion and exclusion criteria were used in different articles and are described in methodology section. In that publication we analysed basic clinical data. Moreover, the concentration of classical plasma lipoproteins, fasting glucose and creatinine were obtained from blood samples. Each patient underwent the echocardiography with the assessment of left ventricular ejection fraction (LVEF); furthermore, the severity of coronary artery disease (CAD) was assessed with the Gensini score system. Results: In the first study, performed among non-diabetic patients with AMI, there was no difference in ; the median TyG Index value among patients with and without incidence of MACE at a 1-year follow-up (8.73 (8.36–9.08) versus 8.81 (8.5–9.17); p= 0.09). Moreover, in univariate regression analysis TyG Index was not a predictor of these events. In multivariable model, only previously diagnosed CAD was an independent predictor of MACE. Additionally, TyG Index was not an indicator of all-cause mortality. In the second group of the patients, diagnosed with NSTEMI, we assessed three other nonclassical lipid parameters - CRI I, CRI II and TG/HDL-C. In the entire study population only CRI II was predictor of MACE ( odds ratio (OR)=0.83 (95 % CI:0.7–0.97, p=0.02)) but only in univariate regression analysis. It was insignificant in multivariable model. After the division of the patients for subpopulations, according to the presence of diabetes or CAD diagnosed prior to admission, none of the non-classical lipid parameters was a predictor of MACE among those with diabetes, with CAD diagnosed prior to the current admission and among those with first manifestation of CAD. Only among non-diabetic patients both CRI I and CRI II were predictors of MACE, but only in univariate regression analysis (OR=0.73 (95 % CI: 0.58–0.92, p<0.01) for CRI I; OR=0.65 (95 % CI: 0.49–0.86, p<0.01) for CRI II). Both parameters were insignificant in multivariable model. None of the exami ; ned indices was a predictor of all-cause mortality in both univariate and multivariable regression analysis. The final three non-classical lipid parameters were assessed among patients at the age of 60 or older admitted with NSTEMI. In the entire study population only LCI was a predictor of MACE, however only in univariate regression analysis (OR=0.98 (95 % CI: 0.97–0.99, p=0.03)). After dividing patients into two groups according to their age (aged 60–74 years, referred to as young-old, aged 75 years and older, referred to as old-old) we received ambiguous results. In the young-old group only CAD diagnosed prior to admission was an independent predictor of MACE with OR = 2.2 (95% CI: 1.3–3.9, p < 0.01). Additionally, AIP and AC were significant predictors of 1-year all-cause mortality but only in univariate regression analysis (OR=3.2 (95 % CI: 1.1–10.3, p=0.04) for AIP; OR=1.2 (95 % CI: 1–1.4, p=0.04) for AC). Both indices were insignificant in the multivariable model. The results obtained in the old-old group were different. All of the examined indices were significant but negative predictors of MACE, but again only in univariate regression analysis (OR=0.32 (95 % CI: 0.1–0.9, p=0.04) for AIP; OR=0.65 (95 % CI: 0.5–0.85, p=0.01) for AC; OR=0.94 (95 % CI: 0.91–0.98, p=0.03) for LCI). In the multivariable model only diabetes was significant indepen ; dent predictor of those events. Furthermore, AC, eGFR and BMI were significant predictors of all-cause mortality in that group in both univariate and multivariable analysis. However, OR for AC was 1.14 (95% CI: 1–1.3, p = 0.036) therefore, its clinical value was rather poor. Conclusions: Despite the fact that in our research in some subgroups of the patients several non-classical lipid parameters were predictors of MACE and all-cause mortality in 1-year follow-up, we believe that those indices should not be used in everyday clinical practice. None of the examined indices was an independent predictor of MACE in the multivariable model; moreover, only AC was an independent predictor of all-cause mortality but only in one subgroup of the patients. Furthermore, its clinical value was poor. Finally, comprehensive evaluation of the risk of adverse cardiological events and mortality among patients with AMI should focus primarily on basic risk factors and large validated scales.

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2 - studia doktoranckie

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Rada Dyscypliny Nauki medyczne


Konduracka, Ewa

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pol; eng

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Jun 6, 2024

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ZB-140224 Jun 6, 2024


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