Predictive Value of the Lipoprotein(a) to Prealbumin Ratio and of the NT-proBNP to LVEF Ratio for Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome
DOI:
https://doi.org/10.59958/hsf.6681Keywords:
Lipoprotein(a) to prealbumin ratio, NT-proBNP to LVEF ratio, MACE, acute coronary syndrome, PCIAbstract
Objective: To investigate the lipoprotein(a) [Lp(a)] to prealbumin (PA) ratio and the N-terminal pro-brain natriuretic peptide (NT-proBNP) to left ventricular ejection fraction (LVEF) ratio for the prediction of major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: A 1:1 matched case-control study was performed to retrospectively analyze ACS patients who underwent PCI from January 2022 to June 2022. Patients with MACE were selected as the case group (n = 55), and age- and gender-matched patients without MACE were selected as the control group (n = 55). Clinical data for the two groups was compared by univariate and multivariate logistic regression analysis. Risk factors and the odds ratio (OR) for MACE in ACS patients were evaluated, and receiver operating characteristic curve (ROC) were used to evaluate the Lp(a)/PA ratio, the NT-proBNP/LVEF ratio, and their combination for the prediction of MACE in ACS patients. Results: The MACE and non-MACE groups showed statistically significant differences for time from onset to PCI, LVEF, NT-proBNP, white blood cell (WBC), Lp(a), PA, Lp(a)/PA, NT-proBNP/LVEF, number of catheterizations, number of implanted stents >2, and support diameter >3 (p < 0.05). Multivariate logistic regression analysis showed that LVEF, Lp(a)/PA and NT-proBNP/LVEF were independent risk factors for MACE. ROC curve analysis for Lp(a)/PA showed that the area under the curve (AUC) for the prediction of MACE was 0.779 (0.693–0.864), the cut-off point was 1.36, the sensitivity was 69.1%, and the specificity was 74.5%. The AUC for NT-proBNP/LVEF in predicting MACE was 0.827 (0.75–0.904), the cut-off point was 61.04, the sensitivity was 65.5%, and the specificity was 92.7%. For the combination of Lp(a)/PA and NT-proBNP/LVEF, the AUC for the prediction of MACE was 0.889 (0.830–0.947), the cut-off point was 0.37, the sensitivity was 81.8%, and the specificity was 81.8%. Conclusion: The combination of Lp(a)/PA and NT-proBNP/LVEF at admission showed good predictive value for the occurrence of MACE in ACS patients after PCI.
References
Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circulation. Cardiovascular Quality and Outcomes. 2019; 12: e005375.
Lavie CJ. Progress in Cardiovascular Diseases Statistics 2022. Progress in Cardiovascular Diseases. 2022; 73: 94–95.
Geovanini GR, Libby P. Atherosclerosis and inflammation: overview and updates. Clinical Science (London, England: 1979). 2018; 132: 1243–1252.
SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet (London, England). 2015; 385: 2383–2391.
Di Fusco SA, Arca M, Scicchitano P, Alonzo A, Perone F, Gulizia MM, et al. Lipoprotein(a): a risk factor for atherosclerosis and an emerging therapeutic target. Heart (British Cardiac Society). 2022; 109: 18–25.
Sun DW, An L, Lv GY. Albumin-fibrinogen ratio and fibrinogen-prealbumin ratio as promising prognostic markers for cancers: an updated meta-analysis. World Journal of Surgical Oncology. 2020; 18: 9.
Zhang ZY, Ma QY, Zhang D, Peng S, Zhang J. Predictive value of C-reactive protein to high-density lipoprotein cholesterol ratio and N-terminal pro-brain natriuretic peptide to ejection fraction ratio for in-hospital MACE in patients with STEMI after percutaneous coronary intervention. Progress in Cardiology. 2023; 44: 186–192.
Chow SC, Shao J, Wang H. Sample Size Calculation in Clinical Research. Marcel Dekker: New York. 2008.
Zeymer U, Bueno H, Granger CB, Hochman J, Huber K, Lettino M, et al. Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: A document of the Acute Cardiovascular Care Association of the European Society of Cardiology. European Heart Journal. Acute Cardiovascular Care. 2020; 9: 183–197.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology. 2018; 72: 2231–2264.
Wang X, Fu X H, Wang Z J, Xiao K. Association between lipoprotein a and left ventricular thrombosis after acute anterior myocardial infarction. Journal of Hebei Medical University. 2020; 41: 754–792.
Labudovic D, Kostovska I, Tosheska Trajkovska K, Cekovska S, Brezovska Kavrakova J, Topuzovska S. Lipoprotein(a) - Link between Atherogenesis and Thrombosis. Prague Medical Report. 2019; 120: 39–51.
Orsó E, Schmitz G. Lipoprotein(a) and its role in inflammation, atherosclerosis and malignancies. Clinical Research in Cardiology Supplements. 2017; 12: 31–37.
Wilson DP, Jacobson TA, Jones PH, Koschinsky ML, McNeal CJ, Nordestgaard BG, et al. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. Journal of Clinical Lipidology. 2019; 13: 374–392.
Takahashi D, Wada H, Ogita M, Yasuda K, Nishio R, Takeuchi M, et al. Impact of Lipoprotein(a) as a Residual Risk Factor in Long-Term Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Treated With Statins. The American Journal of Cardiology. 2022; 168: 11–16.
Sakata K, Kumakura H, Funada R, Matsuo Y, Nakashima K, Iwasaki T, et al. Lipoprotein(a) is a Promising Residual Risk Factor for Long-Term Clinical Prognosis in Peripheral Arterial Disease. Annals of Vascular Diseases. 2022; 15: 186–192.
Suwa S, Ogita M, Miyauchi K, Sonoda T, Konishi H, Tsuboi S, et al. Impact of Lipoprotein (a) on Long-Term Outcomes in Patients with Coronary Artery Disease Treated with Statin After a First Percutaneous Coronary Intervention. Journal of Atherosclerosis and Thrombosis. 2017; 24: 1125–1131.
Yamada T, Haruki S, Minami Y, Numata M, Hagiwara N. The C-reactive protein to prealbumin ratio on admission and its relationship with outcome in patients hospitalized for acute heart failure. Journal of Cardiology. 2021; 78: 308–313.
Wang W, Wang CS, Ren D, Li T, Yao HC, Ma SJ. Low serum prealbumin levels on admission can independently predict in-hospital adverse cardiac events in patients with acute coronary syndrome. Medicine. 2018; 97: e11740.
Daniels LB, Clopton P, deFilippi CR, Sanchez OA, Bahrami H, Lima JAC, et al. Serial measurement of N-terminal pro-B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA). American Heart Journal. 2015; 170: 1170–1183.
Liu HW, Han YL, Jin QM, Wang XZ, Ma YY, Wang G, et al. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention. Chinese Medical Journal. 2018; 131: 1412–1419.
Bai J, Han L, Liu H. Combined use of high-sensitivity ST2 and NT-proBNP for predicting major adverse cardiovascular events in coronary heart failure. Annals of Palliative Medicine. 2020; 9: 1976–1989.
Qin Z, Du Y, Zhou Q, Lu X, Luo L, Zhang Z, et al. NT-proBNP and Major Adverse Cardiovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Primary Percutaneous Coronary Intervention: A Prospective Cohort Study. Cardiology Research and Practice. 2021; 2021: 9943668.
Li Z, Rong H, Wu W, Huang T, Xu J. Application Value of NT-proBNP Combined with NLR in Evaluation of Major Adverse Cardiac Events in Elderly Patients with Chronic Heart Failure. Emergency Medicine International. 2022; 2022: 3689445.
Yuan D, Wang P, Jia S, Zhang C, Zhu P, Jiang L, et al. Lipoprotein(a), high-sensitivity C-reactive protein, and cardiovascular risk in patients undergoing percutaneous coronary intervention. Atherosclerosis. 2022; 363: 109–116.