Association of ApoA1 to ApoB ratio and other serum ratios with ischemia and reperfusion injury in patients with acute myocardial infarction

Background: New evidence has confirmed that the key initiating event in atherogenesis is the retention of low-density lipoprotein cholesterol (LDL-C) and other cholesterol-rich apolipoprotein (Apo). ApoB is the main composition of LDL and makes up 80% of the proteins in LDL. So, the latest guidelines suggest that ApoB may be a better indicator of atherosclerotic lipoprotein risk. The ApoA1 to ApoB ratio (A1BR) has been proved as a potential biomarker and lots of evidence shown that has significantly related with coronary heart disease (CHD). Hence, we plan to research the connection between A1BR and ischemia and reperfusion injury (IRI) events that restoring blood perfusion and oxygen supply to some ischemic tissues and organs may aggravate tissue damage including accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, atrioventricular block and sinus bradycardia in patients who suffered acute myocardial infarction (AMI) and performed selective coronary angiography (CAG).Methods: We investigated retrospectively 566 participants with AMI who CAG from the Affiliated Hospital of Qingdao University. The basic information including socioeconomic status and laboratory characteristic were recruited. On the basis of the presence of IRI events such as accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, atrioventricular block and sinus bradycardia, the participants were classified into the IRI group (n=142) and the non- IRI group (n =424). Then we analyze the data via statistic methods.Results: The A1BR in the IRI group was obviously lower compared with those in the non-IRI group [1.35 (1.11, 1.56) vs. 1.55 (1.28, 1.89), Z=−7.586, P=0.000]. Otherwise, Gensini score (GS), EF%, neutrophil, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR); Total monocyte-to-HDL-C ratio (MHR), HDLC, ApoB between the two groups (all P<0.05). A1BR was identified as an independent protective factor of IRI events [odds ratio (OR): 0.225, 95% confidential interval (CI): 0.131–0.389, P=0.000]. Also, we found that NLR was an independent risk factor of IRI events (OR: 1.072, 95% CI: 1.022–1.126, P=0.005). An A1BR had 74.65% sensitivity and 60.38% specificity in predicting the development of IRI events.Conclusions: This study demonstrated that A1BR levers are lower in patients with IRI events after PCI compared to patients without IRI events. Moreover the A1BR levers also have tight association with GS. A1BR as a rising marker is independently associated with the occurrence of IRI events in patients with AMI and NLR, PLR also have association with IRI events. Because of this indicator is cheap and easy to get, A1BR could become a better choice to identify participants in danger so as to take effective measures to avoid the occurrence of IRI events.