Participants
Patients who underwent concurrent coronary angiography in the Department of Cardiology of our hospital from January 2019 to December 2021 were included in the study. Exclusion criteria were as follows: 1) Previous myocardial infarction, coronary intervention therapy, coronary artery bypass grafting; 2) Acute cerebral infarction occurring within 6 months; 3) Other heart diseases, such as congenital heart disease, valvular heart disease, or great vascular disease; 4) Complicated with malignant tumor, hematological diseases, or autoimmune diseases; 5) Complicated with acute and chronic infectious diseases. CAD was diagnosed according to the American College of Cardiology/American Heart Association clinical guidelines for CAD: Stenosis of <50% of any of the following major coronary arteries, including the left main trunk, left anterior descending branch, left circumflex branch, right coronary artery or its major branches of vessel diameter >1.5 mm (such as diagonal branch, obtuse margin branch, posterior left ventricular branch, posterior descending branch) [8]. After admission, all patients were treated with aspirin and ticagrelor/clopidogrel. Demographic characteristics of all patients were collected, including gender, age, hypertension, diabetes, smoking status, height, weight, and other data. Body Mass Index (BMI, weight (kg) / [height (m)]2) was also calculated, This study was approved by the Ethics Committee of the 904th Hospital of Joint Logistic Support Force of PLA and all patients signed informed consent.
Laboratory parameters
After admission, each patient fasted for 10-12 h and venous blood was collected the next morning and assayed for blood routine examination and routine biochemistry, including white blood cell (WBC) count, triglyceride, total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), creatinine, and CRP. LCR was calculated as follows: lymphocyte count (103/μL)/CRP (mg/L), SII, NLR, and PLR were also calculated.
Angiography
Judkins-style coronary angiography was performed in each patient, and the degree of coronary stenosis was determined by at least two interventional cardiologists according to the angiography results [8]. The Gensini score was used to determine the severity of coronary stenosis [9, 10]. The Gensini score evaluation criteria were as follows: (1) Stenosis degree score: the stenosis degree of 1-25% was recorded as 1 point; 26–50%, 2 points; 51–75%, 4 points; 76–90%, 8 points; 91–99%, 16 points; and 100%, 32 points. (2) Lesion score: left trunk 5 points, proximal left anterior descending branch 2.5 points, middle left anterior descending branch 1.5 points, aorta and first diagonal branch 1 point, second diagonal branch 0.5 point, distal left anterior descending branch 1 point; the proximal left circumflex branch 2.5 points, middle left circumflex branch 2.5 points, distal left circumflex branch 1 point, blunt edge branch 0.5 point; the proximal segment of a right coronary artery 1 point, middle segment of a right coronary artery 1 point, the distal segment of a right coronary artery 1 point, distal segment of a right coronary artery 1 point, posterior descending branch 1 point, posterior branch of the left ventricle 0.5 point. The Gensini score is the sum of the degree score of coronary stenosis and the lesion site score; 0 points is considered normal, 1-30 points is considered to be mild CAD, ≥30 points is considered to be severe CAD.
Statistical analyses
The counting data were expressed as the number of use cases and percentage, and the measurement data with non-normal distribution were expressed by the median (quartile); Chi squared test was used for counting data, nonparametric test was used for non-normal distribution measurement data, and Kolmogorov Smirnov test was used to detect whether the data conformed to the normal distribution. The propensity score matching (PSM) method was used to balance the clinical baseline data of the two groups, and the patients were included in the regression model variables by logistic regression method, including sex, age, hypertension, diabetes, age, body mass index, and LDL-C, and the 1:1 nearest neighbor matching method (caliper value =0.02) was adopted, giving priority to accurate matching. If the control group had multiple observation objects that met the matching conditions, one person was randomly selected. Pearson and Spearman correlation coefficients were used for the correlation analysis. The data in the general data sheet were dichotomized according to the median and included in univariate logistic regression analysis. The relevant influencing factors were screened according to the standard of P<0.1 and included in the multivariate logistic regression analysis to determine the independent related risk factors of CAD and severe coronary artery stenosis. SPSS version 26.0 (SPSS Inc, Chicago, Illinois, USA) was used to analyze the data.