A New Predictor of Obstructive Coronary Artery Ectasia in Patients with Non-ST-Elevation Acute Coronary Syndrome: The Atherogenic Index of Plasma
Un nuevo predictor de ectasia obstructiva de la arteria coronaria en pacientes con síndrome coronario agudo sin elevación del segmento ST: el índice aterogénico del plasma
Uğur Küçük, Kadir Arslan
Abstract
Introduction: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders with a clinical spectrum ranging from asymptomatic cases to myocardial infarction. Atherosclerosis plays a pivotal role in the pathogenesis of CAE. Recently, it has been determined that the atherogenic index of plasma (AIP) is a strong predictive marker for atherosclerosis. The aim of this study was to investigate whether there is a relationship between obstructive CAE and AIP in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).
Materials and methods: In this retrospective study, hospital electronic patient records were retrospectively examined. A total of 213 NSTE-ACS patients were included in the study. Patients were divided into two groups according to non-obstructive and obstructive CAE. The AIP value was compared between groups and regression analysis evaluated whether it is an indicator to predict the risk of obstructive CAE.
Results: The AIP value was found to be numerically and statistically significant in the obstructive CAE group compared to the non-obstructive CAE group. The multivariate logistic regression analysis identified AIP as a predictor of obstructive CAE in NSTE-ACS patients in the receiver operating curve analysis, AIP values above 0.33 had 90% sensitivity and 68% specificity to predict obstructive CAE in NSTE-ACS patients.
Conclusions: AIP values were increased in the presence of obstructive CAE in NSTE-ACS patients. Our findings suggest that AIP may be involved in the pathogenesis of obstructive CAE.
Keywords
Resumen
Introducción: La ectasia arterial coronaria (EAC) es uno de los trastornos cardiovasculares poco frecuentes con un espectro clínico que va desde casos asintomáticos hasta infarto de miocardio. La aterosclerosis juega un papel fundamental en la patogenia de la CAE. Recientemente, se ha determinado que el índice aterogénico del plasma (AIP) es un fuerte marcador predictivo de aterosclerosis. El objetivo de este estudio fue investigar si existe una relación entre el CAE obstructivo y la PAI en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST).
Materiales y métodos: En este estudio retrospectivo, se examinaron retrospectivamente las historias clínicas electrónicas de los pacientes. Se incluyeron en el estudio un total de 213 pacientes con SCASEST. Los pacientes se dividieron en dos grupos según el CAE obstructivo y no obstructivo. El valor de AIP se comparó entre grupos y el análisis de regresión evaluó si es un indicador para predecir el riesgo de EAC obstructivo.
Resultados: Se encontró que el valor AIP era numérica y estadísticamente significativo en el grupo CAE obstructivo en comparación con el grupo CAE no obstructivo. El análisis de regresión logística multivariable identificó a la AIP como predictor de EAC obstructiva en pacientes con SCASEST en el análisis de la curva operativa del receptor, valores de AIP superiores a 0,33 tenían una sensibilidad del 90 % y una especificidad del 68 % para predecir EAC obstructiva en pacientes con SCASEST.
Conclusiones: Los valores de AIP se incrementaron en presencia de EAC obstructivo en pacientes con SCASEST. Nuestros hallazgos sugieren que AIP puede estar involucrado en la patogenia de CAE obstructivo.
Palabras clave
References
1. Endoh S, Andoh H, Sonoyama K, Furuse Y, Ohtahara A, Kasahara T. [Clinical features of coronary artery ectasia]. J Cardiol. 2004;43(2):45-52.
2. Pinar Bermúdez E, López Palop R, Lozano Martínez-Luengas I, Cortés Sánchez R, Carrillo Sáez P, Rodríguez Carreras R, et al. [Coronary ectasia:
prevalence, and clinical and angiographic characteristics]. Rev Esp Cardiol. 2003;56(5):473-9. doi: 10.1016/s0300-8932(03)76902-4.
3. Iwańczyk S, Borger M, Kamiński M, Chmara E, Cieślewicz A, Tykarski A, et al. Inflammatory response in patients with coronary artery ectasia and coronary artery disease. Kardiol Pol. 2019;77(7-8):713-5. doi: 10.33963/KP.14812.
4. Yilmaz H, Tayyareci G, Sayar N, Gurkan U, Tangurek B, Asilturk R, et al. Plasma soluble adhesion molecule levels in coronary artery ectasia. Cardiology. 2006;105(3):176-81. doi: 10.1159/000091414.
5. Antoniadis AP, Chatzizisis YS, Giannoglou GD. Pathogenetic mechanisms of coronary ectasia. Int J Cardiol. 2008;130(3):335-43. doi: 10.1016/j.ijcard.2008.05.071.
6. Lehmann N, Erbel R, Mahabadi AA, Rauwolf M, Möhlenkamp S, Moebus S, et al. Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall). Circulation. 2018;137(7):665-79. doi: 10.1161/CIRCULATIONAHA.116.027034.
7. Weber C, Noels H. Atherosclerosis: current pathogenesis and therapeutic options. Nat Med. 2011;17(11):1410-22. doi: 10.1038/nm.2538.
8. Dobiásová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001;34(7):583-8. doi: 10.1016/s0009-9120(01)00263-6.
9. Onat A, Can G, Kaya H, Hergenç G. "Atherogenic index of plasma" (log10 triglyceride/high-density lipoprotein-cholesterol) predicts high blood pressure, diabetes, and vascular events. J Clin Lipidol. 2010;4(2):89-98. doi: 10.1016/j.jacl.2010.02.005.
10. Dobiásová M, Frohlich J, Sedová M, Cheung MC, Brown BG. Cholesterol esterification and atherogenic index of plasma correlate with lipoprotein size and findings on coronary angiography. J Lipid Res. 2011;52(3):566-71. doi: 10.1194/jlr.P011668.
11. Si Y, Fan W, Han C, Liu J, Sun L. Atherogenic Index of Plasma, Triglyceride-Glucose Index and Monocyte-to-Lymphocyte Ratio for Predicting Subclinical Coronary Artery Disease. Am J Med Sci. 2021;362(3):285-90. doi: 10.1016/j.amjms.2021.05.001.
12. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393.
13. Boles U, Zhao Y, David S, Eriksson P, Henein MY. Pure coronary ectasia differs from atherosclerosis: morphological and risk factors analysis. Int J Cardiol. 2012;155(2):321-3. doi: 10.1016/j.ijcard.2011.12.010.
14. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol. 1976;37(2):217-22. doi: 10.1016/0002-9149(76)90315-5.
15. Devabhaktuni S, Mercedes A, Diep J, Ahsan C. Coronary Artery Ectasia-A Review of Current Literature. Curr Cardiol Rev. 2016;12(4):318-23. doi: 10.2174/1573403x12666160504100159.
16. Krüger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A. Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms ("dilated coronopathy"). J Am Coll Cardiol. 1999;34(5):1461-70. doi: 10.1016/s0735-1097(99)00375-7.
17. Manginas A, Cokkinos DV. Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J. 2006;27(9):1026-31. doi: 10.1093/eurheartj/ehi725.
18. Erden I, Erden EC, Ozhan H, Karabulut A, Ordu S, Yazici M. Outcome of primary percutaneous intervention in patients with infarct-related coronary artery ectasia. Angiology. 2010;61(6):574-9. doi: 10.1177/0003319709361197.
19. Koba S, Hirano T. [Dyslipidemia and atherosclerosis]. Nihon Rinsho. 2011;69(1):138-43.
20. Savel J, Lafitte M, Pucheu Y, Pradeau V, Tabarin A, Couffinhal T. Very low levels of HDL cholesterol and atherosclerosis, a variable relationship--a review of LCAT deficiency. Vasc Health Risk Manag. 2012;8:357-61. doi: 10.2147/VHRM.S29985.
21. Zhou K, Qin Z, Tian J, Cui K, Yan Y, Lyu S. The Atherogenic Index of Plasma: A Powerful and Reliable Predictor for Coronary Artery Disease in Patients With Type 2 Diabetes. Angiology. 2021;72(10):934-41. doi: 10.1177/00033197211012129.
22. Mao Q, Zhou D, Li Y, Wang Y, Xu SC, Zhao XH. The Triglyceride-Glucose Index Predicts Coronary Artery Disease Severity and Cardiovascular Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. Dis Markers. 2019;2019:6891537. doi: 10.1155/2019/6891537.
23. Ji J, Pan E, Li J, Chen J, Cao J, Sun D, et al. Classical risk factors of cardiovascular disease among Chinese male steel workers: a prospective cohort study for 20 years. BMC Public Health. 2011;11:497. doi: 10.1186/1471-2458-11-497.
24. Demircan G, Özel D, Duran Özel B, Özkan F, Halefoğlu AM, Özel A, et al. Evolution of intima media thickness and breast arterial calcifications as cardiovascular risk factor, effect of pregnancy and breast feeding. Med Bull Sisli Etfal Hosp. 2016;50:39-44. doi: 10.5350/SEMB.20160107014832.
25. Zhu L, Lu Z, Zhu L, Ouyang X, Yang Y, He W, et al. Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people. Kardiol Pol. 2015;73(10):931-8. doi: 10.5603/KP.a2015.0086.
26. Mudhaffar SK. Atherogenic Index of Plasma (AIP) As a Parameter in Predicting Cardiovascular Risk in Males Compared To the Conventional Dyslipidemic Indices (Cholesterol Ratios). Karbala J Med. 2013;6(1):1506-13.
27. Wu TT, Gao Y, Zheng YY, Ma YT, Xie X. Atherogenic index of plasma (AIP): a novel predictive indicator for the coronary artery disease in
postmenopausal women. Lipids Health Dis. 2018;17(1):197. doi: 10.1186/s12944-018-0828-z.
28. Kraaijenhof JM, Hovingh GK, Stroes ESG, Kroon J. The iterative lipid impact on inflammation in atherosclerosis. Curr Opin Lipidol. 2021;32(5):286-92. doi: 10.1097/MOL.0000000000000779.
29. Guo Q, Zhou S, Feng X, Yang J, Qiao J, Zhao Y, et al. The sensibility of the new blood lipid indicator--atherogenic index of plasma (AIP) in menopausal women with coronary artery disease. Lipids Health Dis. 2020;19(1):27. doi: 10.1186/s12944-020-01208-8.
30. Cure E, Cumhur Cure M. Comment on "The relationship between atherogenic index of plasma and no-reflow in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention". Int J Cardiovasc Imaging. 2020;36(5):797-8. doi: 10.1007/s10554-020-01781-0.
31. Singh A, Puhan R, Pradhan A, Ali W, Sethi R. Small Dense Low-Density Lipoprotein for Risk Prediction of Acute Coronary Syndrome. Cardiol Res. 2021;12(4):251-7. doi: 10.14740/cr1254.
Submitted date:
08/31/2022
Reviewed date:
09/18/2022
Accepted date:
09/20/2022
Publication date:
09/20/2022