Associations between various lipid indices and coronary collateral circulation in patients with acute ST-segment
Tianfeng Zhang1, Chenghua Wang1, Zhenghui Wang1
1Department of Cardiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Insights
Elevated LDL-C, non-HDL-C, and the non-HDL-C/HDL-C ratio are linked to poor coronary collateral circulation (CCC) in ST-segment elevation myocardial infarction (STEMI) patients. Non-HDL-C shows the strongest association, highlighting its clinical importance.
Area of Science:
- Cardiology
- Lipid Metabolism
- Myocardial Infarction Research
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular condition.
- Coronary collateral circulation (CCC) plays a vital role in myocardial salvage post-STEMI.
- The relationship between various lipid indices and CCC status in STEMI patients requires further elucidation.
Purpose of the Study:
- To investigate the association between multiple lipid indices and the quality of coronary collateral circulation (CCC) in patients with acute ST-segment elevation myocardial infarction (STEMI).
- To identify specific lipid parameters that predict poor CCC in STEMI patients.
Main Methods:
- A cross-sectional retrospective study of 421 STEMI patients who underwent coronary angiography.
- Patients were classified into poor (Rentrop grade 0-1) and good (Rentrop grade 2-3) CCC groups.
- Analysis included multivariate logistic regression and ROC curve analysis of various lipid parameters.
Main Results:
- Higher HDL-C quartiles were associated with reduced odds of poor CCC.
- Elevated LDL-C, non-HDL-C, and non-HDL-C/HDL-C quartiles were significantly associated with increased odds of poor CCC.
- Non-HDL-C demonstrated the strongest predictive performance for poor CCC.
Conclusions:
- Lipid indices, particularly LDL-C, non-HDL-C, and the non-HDL-C/HDL-C ratio, are significantly associated with impaired CCC in STEMI patients.
- Non-HDL-C emerges as a key indicator of CCC dyscrasia, warranting early clinical attention.
- These findings underscore the importance of lipid management in optimizing outcomes for STEMI patients.
Background:
This study aims to evaluate the association between multiple lipid indices and coronary collateral circulation (CCC) in patients diagnosed with acute ST-segment elevation myocardial infarction (STEMI).
Methods:
This was a cross-sectional retrospective study involving 421 patients with STEMI who underwent coronary angiography between January 2022 and December 2024. Participants were categorized into a poor CCC group (Rentrop grade 0-1) and a good CCC group (Rentrop grade 2-3) according to Rentrop grading criteria. The following lipid parameters were evaluated as both continuous and categorical variables: total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), lipoprotein(a) [Lp(a)], apolipoprotein B (ApoB), apolipoprotein A-I (ApoA-I), non-HDL-C/HDL-C, ApoB/ApoA-I, atherogenic index of plasma (AIP), and lipoprotein composite index (LCI). The associations between these lipid indices and CCC status were assessed using multivariate logistic regression and receiver operating characteristic (ROC) curve analysis.
Results:
Multivariate logistic regression analysis revealed that higher HDL-C quartiles were significantly associated with reduced odds of poor CCC (odds ratio [OR]: 0.544, 95% confidence interval [CI]: 0.351-0.771, P < 0.05), whereas elevated LDL-C (OR: 29.299, 95% CI: 3.562-240.976, P < 0.05), non-HDL-C (OR: 50.140, 95% CI: 5.408-464.834, P < 0.01), and non-HDL-C/HDL-C (OR: 4.510, 95% CI: 1.186-25.368, P < 0.05) quartiles were significantly associated with increased odds of poor CCC. Receiver operating characteristic (ROC) curve analysis demonstrated that LDL-C (cutoff: 3.265, AUC: 0.647, 95% CI: 0.573-0.721, P < 0.001), non-HDL-C (cutoff: 2.735, AUC: 0.752, 95% CI: 0.688-0.816, P < 0.001), and non-HDL-C/HDL-C (cutoff: 2.393, AUC: 0.686, 95% CI: 0.611-0.761, P < 0.001) exhibited favorable predictive performance for poor CCC. Stratification analysis showed that the highest prevalence of poor CCC was observed in patients with concurrently elevated levels of LDL-C, non-HDL-C, and non-HDL-C/HDL-C.
Conclusion:
Several lipid indices-including LDL-C, non-HDL-C, and the non-HDL-C/HDL-C ratio-are significantly associated with impaired CCC in patients with STEMI. Notably, non-HDL-C exhibits the strongest association with CCC dyscrasia and therefore warrants early clinical attention.
Related Concept Videos
01:26Coronary Artery Disease II: Pathophysiology
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management