Akut koroner sendromda yaşla çarpılmış LDL yükü ile SYNTAX skoru ile değerlendirilen koroner anatomik karmaşıklık arasındaki ilişki

Öz

Aim: Akut koroner sendromda (AKS) koroner anatomik kompleksisite, yalnızca eş zamanlı risk faktörlerini değil, aterosklerozun kümülatif yükünü yansıtır. Düşük yoğunluklu lipoprotein kolesterolü (LDL-K), aterosklerotik kardiyovasküler hastalıkla nedensel olarak ilişkili olmakla birlikte, tek bir zaman noktasında ölçülen LDL-K düzeyleri yaşam boyu maruziyeti yeterince yansıtmaz. Yaş ile çarpılmış LDL kolesterol yükü (AM-LDL), kümülatif LDL maruziyetinin pratik bir göstergesi olarak önerilmiş olsa da, koroner anatomik kompleksisite ile ilişkisi net değildir. Gereç ve Yöntemler: Bu çalışmada, AKS hastalarında AM-LDL ile SYNTAX skoru kullanılarak değerlendirilen koroner anatomik kompleksisite arasındaki ilişkinin araştırılması ve bu göstergenin açıklayıcı değerinin geleneksel lipid parametreleri ile karşılaştırılması amaçlanmıştır. Bu retrospektif, tek merkezli çalışmaya, koroner anjiyografi uygulanan 208 ardışık AKS hastası dahil edilmiştir. AM-LDL, yaş (yıl) ile başvuru anındaki LDL-K (mg/dL) çarpılarak hesaplanmıştır. Koroner anatomik kompleksisite SYNTAX skoru ile nicel olarak değerlendirilmiştir. AM-LDL ile SYNTAX skoru arasındaki ilişkiler korelasyon analizi, çok değişkenli doğrusal ve lojistik regresyon modelleri, çeyreklik (quartil) bazlı analizler ve kısıtlı kübik spline regresyonu kullanılarak incelenmiştir. Öngörü performansı, ROC analizi ile değerlendirilmiştir. Bulgular: AM-LDL ile SYNTAX skoru arasında güçlü ve pozitif bir korelasyon saptanmıştır (Spearman ρ = 0,593; p < 0,001). Çok değişkenli analizlerde, yüksek AM-LDL değerleri artmış koroner anatomik kompleksisite ile bağımsız olarak ilişkili bulunmuştur. AM-LDL’de her 1 standart sapmalık artış, yüksek koroner kompleksisite (SYNTAX ≥23) olasılığında artış ile ilişkilidir. Kısıtlı kübik spline analizi doğrusal bir doz–yanıt ilişkisini göstermiştir. Geleneksel lipid parametreleri ise daha zayıf veya tutarsız ilişkiler sergilemiştir. Sonuç: AKS hastalarında koroner anatomik kompleksisite, yalnızca başvuru anındaki lipid düzeylerinden ziyade kümülatif aterojenik maruziyet ile yakından ilişkilidir. AM-LDL, yaşam boyu LDL yükünün basit bir göstergesi olup SYNTAX skoru ile tanımlanan koroner kompleksisitela bağımsız olarak ilişkilidir.

Anahtar Kelimeler

• Akut koroner sendrom
• koroner anatomik karmaşıklık
• SYNTAX skoru
• düşük yoğunluklu lipoprotein kolesterol (LDL kolesterol)
• kümülatif LDL yükü
• yaşla çarpılmış LDL indeksi.

Association Between Age-Multiplied LDL Burden and Coronary Anatomical Complexity Assessed by SYNTAX Score in Acute Coronary Syndrome

Öz

Aim: Coronary anatomical complexity in acute coronary syndrome (ACS) reflects the cumulative burden of atherosclerosis rather than contemporaneous risk factors alone. While low-density lipoprotein cholesterol (LDL-C) is causally linked to atherosclerotic cardiovascular disease, single-time-point LDL-C measurements fail to capture lifetime exposure. The age-multiplied LDL cholesterol burden (AM-LDL) has emerged as a pragmatic surrogate of cumulative LDL exposure; however, its relationship with coronary anatomical complexity remains unclear. The aim of this study is to investigate the association between AM-LDL and coronary anatomical complexity assessed by the SYNTAX score in patients with ACS, and to compare its explanatory value with conventional lipid parameters. Material and Methods: This retrospective, single-centre study included 208 consecutive patients presenting with ACS who underwent coronary angiography. AM-LDL was calculated as age (years) multiplied by admission LDL-C (mg/dL). Coronary anatomical complexity was quantified using the SYNTAX score. Associations between AM-LDL and SYNTAX score were evaluated using correlation analysis, multivariable linear and logistic regression models, quartile-based analyses, and restricted cubic spline regression. Incremental predictive performance was assessed using receiver operating characteristic analysis. Results: AM-LDL showed a moderate positive correlation with SYNTAX score (Spearman’s ρ = 0.593, p < 0.001). In multivariable analyses, higher AM-LDL was independently associated with greater coronary complexity. Each 1-standard deviation increase in AM-LDL was associated with increased odds of high coronary complexity (SYNTAX ≥23). Restricted cubic spline analysis demonstrated a linear dose–response relationship. Conventional lipid parameters showed weaker or inconsistent associations. Conclusions: In ACS patients, coronary anatomical complexity is closely associated with cumulative atherogenic exposure rather than admission lipid levels alone. AM-LDL provides a simple surrogate of lifetime LDL burden and is independently linked to SYNTAX-defined coronary complexity.

Anahtar Kelimeler

• acute coronary syndrome
• coronary anatomical complexity
• SYNTAX score
• low-density lipoprotein cholesterol
• cumulative LDL burden
• age-multiplied LDL index

Kaynakça

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