GIÁ TRỊ CỦA TỶ SỐ APOLIPOPROTEIN B/ APOLIPOPROTEIN A-I TRONG DỰ ĐOÁN MỨC ĐỘ TỔN THƯƠNG MẠCH VÀNH THEO THANG ĐIỂM SYNTAX VÀ KẾT CỤC NỘI VIỆN Ở BỆNH NHÂN HỘI CHỨNG ĐỘNG MẠCH VÀNH CẤP

Abstract

Objective: This study aimed to determine the value of the Apolipoprotein B/Apolipoprotein A-I (ApoB/ApoA-I) ratio in predicting the complexity of coronary artery disease (CAD) assessed by the SYNTAX score and in-hospital adverse outcomes in patients with acute coronary syndrome (ACS). Subjects and Methods: A prospective cohort study was conducted on 139 patients diagnosed with ACS who were admitted and underwent coronary angiography at Tam Duc Heart Hospital from November 2024 to April 2025. Clinical, laboratory data, ApoB, ApoA-I levels, and SYNTAX scores were collected. Receiver Operating Characteristic (ROC) curve analysis was used to determine optimal cut-off points, and multivariate logistic regression was used to identify independent predictors. Results: The mean age of the study population was 64.6 ± 10.6 years , with 71.9% being male. The prevalence of multi-vessel disease was very high (91.4%) , and 30.9% of patients had highly complex lesions (SYNTAX > 32). The ApoB/ApoA-I ratio increased significantly with higher SYNTAX score categories (p < 0.001). Predicting SYNTAX > 32: The Area Under the Curve (AUC) was 0.887. At a cut-off of 0.755, sensitivity was 83.7%, specificity was 83.3%, and negative predictive value (NPV) was 92%. Predicting in-hospital adverse events: The AUC was 0.877. At a cut-off of 0.805, sensitivity was 92.9% and NPV was 99%. Multivariate logistic regression identified the following independent predictors for a SYNTAX score > 32: an ApoB/ApoA-I ratio ≥ 0.755 (aOR = 6.998; p = 0.031), type 2 diabetes (aOR = 4.08; p = 0.048), and decreased estimated glomerular filtration rate (eGFR) (aOR = 1.039; p = 0.013). Conclusion: The ApoB/ApoA-I ratio is a powerful, valuable, and independent biomarker for predicting the complexity of coronary anatomical lesions and in-hospital events in ACS patients. The use of cut-off points 0.755 and 0.805 can effectively aid in risk stratification and guide treatment strategies.