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. 2023 Nov 3:16:3501-3512.
doi: 10.2147/DMSO.S433876. eCollection 2023.

Elevated ApoB/apoA-1 is Associated with in-Hospital Mortality in Elderly Patients with Acute Myocardial Infarction

Yan Chen  1 , Shengyue Chen  1 , Yuanyuan Han  1 , Qing Xu  1 , Xin Zhao  1
Affiliations

Elevated ApoB/apoA-1 is Associated with in-Hospital Mortality in Elderly Patients with Acute Myocardial Infarction

Yan Chen et al. Diabetes Metab Syndr Obes. .

Abstract

Background: Apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) has been shown to be strongly associated with the risk of future cardiovascular disease, but the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with acute myocardial infarction(AMI) is inconclusive.

Aim: To investigate the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with AMI.

Methods: From December 2015 to December 2021, a total of 1495 elderly AMI patients (aged ≥ 60 years) with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Outcome was defined as all-cause mortality during hospitalization. Multivariate logistic regression and restricted spline cubic (RCS) models were used to evaluate the association between apoB/apoA-1 and in-hospital mortality risk, respectively. Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of apoB/apoA-1 for in-hospital mortality events. Discordance analysis was performed when apoB/apoA-1 and LDL-C/HDL-C were not in concordance.

Results: (1) A total of 128 patients (8.6%) died during hospitalization. Patients in the death group had higher apoB/apoA-1 than those in the non-death group, but lower apoA-1 levels than those in the non-death group, and the difference was statistically significant (P < 0.05); (2) Multivariate logistic regression analysis showed that apoB/apoA-1 was associated with the risk of in-hospital death in elderly AMI patients [Model 3 OR = 3.524 (1.622-7.659), P = 0.001]; (3) ROC curve analysis showed that apoB/apoA-1 (AUC = 0.572, P = 0.011) had some predictive value for the risk of in-hospital death in elderly AMI patients; (4) RCS models showed a linear dose-response relationship between apoB/apoA-1 and in-hospital death after adjusting for confounders (P for non-linearity = 0.762).

Conclusion: ApoB/apoA-1 is associated with the risk of in-hospital death in elderly patients with AMI, and is superior to other blood lipid parameters and blood lipid ratio.

Keywords: acute myocardial infarction; apolipoprotein; elderly; in-hospital death; restricted cubic splines.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The ROC analysis of apoB/apoA-1 predicting in-hospital death in elderly AMI patients. (A) The ROC analysis of apoB/apoA-1 predicting in-hospital death in elderly AMI patients; (B) Comparison of the predictive ability of apoB/apoA-1 on the risk of in-hospital mortality between elderly STEMI patients and NSTEMI patients.
Figure 2
Figure 2
Dose-response relationship between apolipoprotein-related markers and in-hospital mortality in elderly patients with AMI. (A) Unadjusted dose-response relationship between apoB and in-hospital mortality in elderly patients with AMI; (B) Adjusted dose-response relationship between apoB and in-hospital mortality in elderly patients with AMI; (C) Unadjusted dose-response relationship between apoA-1 and in-hospital mortality in elderly patients with AMI; (D) Adjusted dose-response relationship between apoA-1 and in-hospital mortality in elderly patients with AMI; (E) Unadjusted dose-response relationship between apoB/apoA-1 and in-hospital mortality in elderly patients with AMI; (F) Adjusted dose-response relationship between apoB/apoA-1 and in-hospital mortality in elderly patients with AMI. Adjusted factors include sex, age, BMI, type of AMI, eGFR, cardiac troponin I(CTNI), presence of heart failure, diabetes, PCI during hospitalization, history of stroke, and in-hospital medication (Aspirin use and Statins use).
Figure 3
Figure 3
Spearman correlation analysis between each pair of lipid measures.
See this image and copyright information in PMC

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