الفهرس 
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Abstract
Acute coronary syndrome (ACS) is a common fatal disease responsible for millions of deaths worldwide.
It includes clinical manifestations of unstable angina (UA), ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).
Many factors are involved in the pathogenesis of acute myocardial infarction (AMI), and several studies have indicated a lipid metabolism disorder as one of the key factors in the development of this disease.
Today, there has been growing interest in the role of the (TG/HDL-C) ratio as a more practical and easier to use atherogenic marker.
In the general population, an elevated serum TG/HDL-C ratio has been identified as a risk factor for cardiovascular (CV) disease and mortality.
Recently, accumulating studies support the use of the TG/HDL-C ratio as a prominent and accessible indicator of insulin resistance and metabolic syndrome.
This study aimed to assess the TG/HDL-C ratio in patients with ACS as a novel marker of atherosclerosis. This cross-sectional study was conducted on 200 patients admitted to Coronary Care Unit in Sohag University Hospitals.
Summary of our results:
Two hundred patients were included in our study. The age of studied patients ranged from 21 to 85 years with mean age (± SD) was 51.96 ± 13.85 years. The commonest age group found was the age group 31- 40 years in 27.5% followed by age group > 60 years in 27%. There was 154 (77%) males and 46 (23%) females with male to female ratio was 3.35:1.
Clinical history among the studied cases. DM was found in 35% cases, hypertension in 34.5% cases. More than half cases (51%) were current smokers. 14% cases had positive family history of cardiac disease while 9.5% of them had prior PCI or CABG.
Regarding diagnosis, STEMI was the most common diagnosis that found in 62% cases followed by NSTEMI in 26% cases then unstable angina in 12% cases.
The mean systolic blood pressure was 124.60 ± 18.67 mm/Hg and the mean diastolic blood pressure was 79.80 ± 11.94 mm/Hg. The pulse had a mean of 86.35± 16.85 beats/min. Chest examination revealed that most cases (87%) had clear chest, 10.5% cases had fine basal crepitation, 1.5% of them had scattered crepitation all over the chest and 1% of them had coarse crepitation all over the chest. Cardiac examination was normal in all cases. Lower limb edema was observed in 12 (6%) cases..
The mean TG and cholesterol were 154.22 ± 86.73 mg/dl and 188.31± 52.62 mg/dl respectively. The mean HDL and LDL was 39.39± 15.43 mg/dl and 119.87 ± 48.72 mg/dl respectively while the mean VLDL was 31.24± 17.6 mg/dl.
Regarding TG \HDL ratio, it ranged from 1.1 to 33 with mean (±SD) was 4.44± 3.26. Most cases (85.5%) had high ratio.
The mean creatinine and urea levels were 1.29 ± 1.23 mg/dl and 38.09± 27.79 mg/dl respectively. The mean eGFR was 109.16 ± 47.96.
Most cases (61%) had ST- segment elevation. LBBB was found in 12% cases, ST segment depression in 10.5% cases, deep inverted T wave and pathological Q wave in 4.5% cases, biphasic T wave in 4% cases and inverted T wave in 3.5% cases.
Segmental wall-motion abnormalities of the left ventricle (SWMA) were present in 177 (88.9%) cases. Impaired diastolic function was noticed in 6.5% cases while impaired systolic function was found in 7% cases. The ejection fraction (EF) in the studied patients ranged from 23% to 72% with mean (± SD) was 48.79± 9.6%.
It was found that there was significant positive correlation between TG /HDL-C ratio with TG, cholesterol, and LDL while there was significant negative correlation between TG /HDL-C ratio with HDL-C.
By comparing TG /HDL-C ratio related to diagnosis. It was noticed non-significant differences between NSTEMI, STEMI and UA regarding TG /HDL ratio (p>0.05)
Conclusion
This study demonstrated that the increase in TG/HDL-C ratio was significantly associated with the presence of major risk factors for CAD. This study also demonstrated that the increase in TG/HDL-C ratio was significantly associated with presence of high risk atheromateous plaques in ACS. Thus, the TG/HDL-C ratio may be a potential biomarker for assessing atherosclerosis in patients with ACS. The study also demonstrated non-significant differences between NSTEMI, STEMI and UA regarding TG /HDL-c ratio. When comparing TG/HDL-C ratio between the studied three groups, there was no significant difference (p- value = 0.428).
Limitations
Relatively small sample size.
Lack of randomization.
We did not include control group.
Our study is a single center study.
Recommendations
Further clinical studies are needed with multicenter cooperation to validate our findings.
Larger cohort sample size.
Further studies are required to identify the best treatment method with which to mitigate the risk of patients with high TG/HDL-C ratio to protect against cardiovascular events.
Longer duration of follow up are needed to assess the complications.