Monocyte to high density lipoprotein cholesterol ratio is elevated in patients presenting with chest pain and angiographically normal coronary arteries


Atıcı A.

International Atherosclerosis Society HDL-C Workshop Valencia, Valencia, İspanya, 25 - 27 Eylül 2019, no.75, ss.101-103

  • Basıldığı Şehir: Valencia
  • Basıldığı Ülke: İspanya
  • Sayfa Sayısı: ss.101-103

Özet

Background: The main goal for chest pain evaluation is to determine patients with significant coronary obstruction. Novel biomarkers are needed to determine the patients that will benefit from early coronary angiography and revascularization. Despite significant progress in the treatment of atherosclerosis, and vascular disease, our abilities to determine patients with significant coronary obstruction remain to be limited. Imaging technologies are invasive and expose the patients to radiation and intravenous contrast. Current strategies to risk stratify patients with chest pain depend largely on biomarkers. Although coronary angiography is commonly used for diagnosing the presence of coronary artery disease (CAD), it is undesirable for use as a diagnostic tool due to its invasive nature. Novel biomarkers and concepts are needed. In the current practice, troponin its invasive nature. Novel biomarkers and concepts are needed. In the current practice, troponin tests are used in the biochemical evaluation of chest pain. Troponin is a sensitive indicator of myocardial damage. However, troponin as a biomarker of myocardial necrosis, does not indicate the severity of atherosclerosis, inflammation or thrombosis in the pathophysiological pathways. Novel biomarkers are needed to elucidate the biological processes leading to thrombosis and myocardial necrosis. Aim: Monocyte to high density lipoprotein cholesterol ratio (MHR) is a novel biomarker of inflammation and atherosclerosis. The study investigates the use of MHR in determining significant coronary artery obstruction in patients with chest pain who are referred for coronary angiography. Methods: We conducted a retrospective analysis of the patients consecutively admitted for chest pain evaluation that lead to coronary angiography in Medeniyet University Hospital Cardiology Clinic. The period of recruitment time varied from October 2017 to December 2018. In this single-center and cross-sectional study, we include 132 consecutive patients undergoing coronary angiography. Coronary angiography was performed for investigation of ischemic heart disease based on clinical indications (abnormal stress test results, such as dobutamine stress echo, positive treadmill test; and myocardial perfusion scintigraphy or typical chest pain). Two independent and experienced interventional cardiologists, evaluated coronary angiography findings for signficant coronary obstruction. Significant coronary obstruction is defined as the angiographic criteria of as ≥ 70% stenosis of at least one major coronary vessel (≥ 2 mm) caused by atherosclerosis and a vascular event, requiring percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Patients were then divided into two groups: those with and without significant coronary obstruction based on coronary angiography findings. The statistical analyses were performed using SSPS package software (version 21.0). Values of p< 0.05 were considered statistically significant. The Kolmogorov–Smirnov test was used to analyze the distribution pattern. Continuous data (such as MHR) with skewed distribution were presented as median and interquartile range (IQR). A non-parametric test (Mann-Whitney U Test) was used to compare the groups for variables with skewed distribution (i.e. MHR). The receiver operating characteristics (ROC) curve was used to show the sensitivity and specificity of MHR, and the optimal cutoff value for predicting significant coronary obstruction. The local ethics committee approved the study protocol, and all patients provided written informed consent. Results: There were 132 patients in the study (75 % male and 25 % female, mean age 56.5 ± 9.5). Ninety nine patients (75 %) displayed significant coronary obstruction and 33 (25 %) did not have significant CAD by angiographical criteria. Univariate analysis showed that MHR, were significantly higher in patients with significant CAD. Median (IQR) levels of MHR were 16 (9) versus 11 (12) (p=0.036). ROC analysis was performed to determine the MHR cutoff value for predicting significant coronary obstruction. The cutoff value of MHR on admission for predicting significant coronary obstruction was 14.3, with a sensitivity of 62 % and a specificity of 68 % (area under the curve 0.627; Figure 1). Conclusions: In the present study, we report that MHR can predict significant coronary artery obstruction in patients presenting with chest pain. Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and subsequent cardiovascular disease. The results of the study will elucidate the role of MHR to identify high risk patients. Recent clinical and experimental studies define an increasing role of inflammation in CAD. MHR can easily be adopted in daily clinical practice as a quickly accessible and inexpensive parameter to predict the presence of significant coronary obstruction. Further prospective trials are needed to elucidate the clinical significance of MHR in evaluating patients with chest pain.