Application Value of Plasma Lipoprotein-associated Phospholipase A2 Level and AT- Ⅲ Activity on Risk Stratification and Nearby Risk Assessment in Patients With Non-ST Segment Elevation Acute Coronary Syndrome / 中国循环杂志

ABSTRACT

Objective: To explore the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, antithrombinⅢ (AT-Ⅲ ) activity and global registry of acute coronary events (GRACE) score in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS); to analyze the predictive value of Lp-PLA2, AT- Ⅲ on risk stratification and nearby risk assessment in NSTE-ACS patients. Methods: Our research included in 2 groups NSTE-ACS group, n=260 patients with confirmed diagnosis and regular treatment; Control group, n=50 in-hospital patients with coronary angiography excluded coronary artery disease (CAD).plasma level of Lp-PLA2 and AT-Ⅲ activity were examined in the next morning of admission. GRACE score was calculated in NSTE-ACS patients and based on GRACE score, NSTE-ACS group was further divided into 3 subgroups as Low risk subgroup, GRACE score≤108, n=121, Middle risk subgroup, GRACE score (109-140), n=73 and High risk subgroup, GRACE score>140, n=66. The relationships between Lp-PLA2 level, AT-Ⅲ activity and GRACE score were evaluated and the occurrence of major adverse cardiovascular events (MACE) was recorded within 3 months of discharge. Results: ① Compared with Control group, NSTE-ACS group had increased Lp-PLA2 level, P<0.05 and decreased AT-Ⅲ activity, P<0.01. ② In NSTE-ACS group, Lp-PLA2 levels were elevating from Low risk subgroup to Middle risk subgroup and to High risk subgroup accordingly, all P<0.01; compared with Low risk and Middle risk subgroups, High risk subgroup showed decreased AT-Ⅲ activity, P<0.01 and P<0.05; while AT-Ⅲ activity was similar between Low risk and Middle risk subgroups, P>0.05. ③Partial correlation analysis presented that GRACE score was positively related to Lp-PLA2 (r=0.641, P=0.000) and negatively related AT-III (r=-0.179, P=0.006). ④ The area under ROC curve for MACE occurrence in GRACE score was 0.811, in Lp-PLA2 was 0.862 and in AT- Ⅲ was 0.631, all P<0.01; multivariate Logistic regression analysis indicated that Lp-PLA2, GRACE score and HDL-C were the independent predictors for nearby MACE occurrence in NSTE-ACS patients. Conclusion: Blood Lp-PLA2 level and AT-Ⅲ activity were important for risk stratification in NSTE-ACS patients;AT- Ⅲ had less value than Lp-PLA2 and GRACE score for nearby risk assessment.