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

Figures & data

Table 1 Basic Characteristics of Enrolling Patients

Variables	Without Death	With Death	P value
	N=1367	N=128
Male, n(%)	831 (60.8)	69 (53.9)	0.128
BMI (kg/m^2)	25.05 ± 3.51	24.08 ± 3.08	0.001
Age (years)	72.59 ± 8.34	79.80 ± 8.69	0.818
SBP (mmHg)	139 (121,157)	131 (109,151)	0.001
Diabetes, n(%)	580 (42.4)	66 (51.6)	0.046
Heart failure, n(%)	927 (67.8)	119 (93.0)	<0.001
Type of AMI			0.043
NSTEMI, n(%)	981 (71.8)	81 (63.3)
STEMI, n(%)	386 (28.2)	47 (36.7)
Previous stroke, n(%)	104 (7.6)	14 (10.9)	0.182
Hypertension, n(%)	954 (69.8)	81 (63.3)	0.127
PCI during hospitalization, n(%)	855 (62.5)	28 (21.9)	<0.001
eGFR class			<0.001
>60 mL/min/1.73m^2, n(%)	1012 (74.0)	44 (34.4)
30~60 mL/min/1.73m^2, n(%)	184 (13.5)	38 (29.7)
<30 mL/min/1.73m^2, n(%)	171 (12.5)	46 (35.9)
Laboratory data
Na (mmol/L)	140.07 (138.01, 141.90)	138.90 (135.52, 141.01)	<0.001
K (mmol/L)	3.93 (3.65,4.23)	4.14 (3.70,4.59)	<0.001
ALT (U/L)	22.72 (14.97,36.43)	29.72 (16.33,67.68)	<0.001
AST (U/L)	28.07 (19.27,66.87)	76.87 (29.37, 216.30)	<0.001
TG (mmol/L)	1.33 (0.96,1.85)	1.17 (0.93,1.68)	0.029
TC (mmol/L)	4.36 (3.64,5.18)	4.29 (3.46,5.24)	0.771
LDL-C (mmol/L)	2.41 (1.86,3.02)	2.27 (1.73,3.09)	0.383
HDL-C (mmol/L)	1.03 (0.90,1.21)	1.09 (0.85,1.29)	0.501
RC (mmol/L)	0.80 (0.62,1.05)	0.84 (0.65,1.12)	0.272
Non-HDL-C (mmol/L)	3.30 (2.60,4.06)	3.12 (2.50,4.21)	0.541
ApoA-1 (g/L)	1.21 (1.08,1.35)	1.13 (0.92,1.30)	<0.001
ApoB (g/L)	0.87 (0.70,1.03)	0.84 (0.69,1.06)	0.911
ApoB/ApoA-1	0.72 (0.57,0.88)	0.75 (0.60,1.00)	0.007
TG/HDL-C	1.28 (0.87,1.91)	1.15 (0.78,1.73)	0.050
LDL-C/HDL-C	2.30 (1.75,2.98)	2.25 (1.64,3.02)	0.346
Non-HDL-C/HDL-C	3.14 (2.42,4.05)	3.08 (2.28,4.31)	0.549
CTNI (ug/L)	0.98 (0.53,2.65)	5.26 (0.91,19.63)	<0.001
CK-MB (ug/L)	19.65 (15.00,41.24)	22.25 (6.10,96.19)	0.962
Inpatient medication
Aspirin, n(%)	1277 (93.4)	109 (85.2)	0.001
Statins, n(%)	1341 (98.1)	117 (91.4)	<0.001
β-blockers, n(%)	802 (58.7)	59 (46.1)	0.006
ACEI/ARBs, n(%)	635 (46.5)	30 (23.4)	<0.001

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction; PCI, percutaneous coronary intervention; eGFR, estimated glomerular filtration rate; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TG, triglycerides; TC, total cholesterol; LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; RC, remnant cholesterol; ApoA-1, apolipoprotein A-1; ApoB, apolipoprotein B; CTNI, cardiac troponin I; CK-MB creatine kinase-MB; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers.

Table 2 Univariate Analysis of Factors Affecting in-Hospital Mortality in Elderly Patients with AMI

Variables	OR	95% CI	P-value
Male	0.754	0.524–1.086	0.129
Age	1.101	1.077–1.126	<0.001
ApoB/apoA-1	4.002	2.058–7.784	<0.001
BMI	0.922	0.875–0.972	0.003
Diabetes	1.444	1.005–2.076	0.047
History of stroke	1.491	0.827–2.690	0.184
Type of AMI	1.475	1.010–2.152	0.044
Heart failure	6.276	3.157–12.475	<0.001
Hypertension	0.746	0.512–1.088	0.128
PCI during hospitalization	0.168	0.109–0.259	<0.001
CTNI	1.079	1.061–1.098	<0.001
Aspirin use	0.404	0.237–0.688	0.001
Statins use	0.206	0.099–0.428	<0.001
eGFR>60(REF)	/	/	/
30~60	4.750	2.994–7.536	<0.001
<30	6.187	3.969–9.645	<0.001

Abbreviations: OR, odds ratio; CI, confidence interval; AMI, acute myocardial infarction; ApoA-1, apolipoprotein A-1; ApoB, apolipoprotein B; BMI, body mass index; PCI, percutaneous coronary intervention; CTNI, cardiac troponin I; eGFR, estimated glomerular filtration rate.

Table 3 Multivariate Logistic Regression Analysis of ApoB/apoA-1 and in-Hospital Mortality in Elderly Patients with AMI

Variables	OR	95% CI	P-value
Model 1	4.002	2.058–7.784	<0.001
Model 2	3.780	1.913–7.470	<0.001
Model 3	3.524	1.622–7.659	0.001

Note: Model 1 was the crude model. Model 2 was adjusted for sex and age. Model 3 was adjusted for sex, age, body mass index, type of AMI, eGFR, heart failure, Aspirin use, Statins use, cardiac troponin I, diabetes, PCI during hospitalization and history of stroke.

Abbreviations: AMI, acute myocardial infarction; OR, odds ratio; CI, confidence interval; apoA-1, apolipoprotein A-1; apoB, apolipoprotein B.

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.

Abbreviations: AMI, acute myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction. apoA-1, apolipoprotein A-1; apoB, apolipoprotein B.

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).

Abbreviations: AMI, acute myocardial infarction. apoA-1, apolipoprotein A-1; apoB, apolipoprotein B.

Table 4 Multivariate Logistic Regression Analysis Between Discordance Between ApoB/apoA-1 and LDL-C/HDL-C and Risk of in-Hospital Mortality in Elderly AMI Patients

Variables	With Death/n, Individuals	Model 1, OR (95% CI)	Model 2, OR (95% CI)	Model 3, OR (95% CI)
Concordant group	104/1252	1[REF]	1[REF]	1[REF]
Discordant low apoB/apoA-1 group	6/120	0.581 (0.250–1.353)	0.648 (0.274–1.533)	0.643 (0.195–2.117)
Discordant high apoB/apoA-1 group	18/123	1.892 (1.104–3.243)	1.886 (1.078–3.301)	1.139 (0.575–2.253)

Note: Concordant group: apoB/apoA-1 < median and LDL-C/HDL-C < median; apoB/apoA-1 ≥ median and LDL-C/HDL-C ≥ median. Discordant low apoB/apoA-1 group: apoB/apoA-1 < median and LDL-C/HDL-C ≥ median. Discordant high apoB/apoA-1 group: apoB/apoA-1 ≥ median and LDL-C/HDL-C < median. Apo-B/apoA-1 median = 0.725; LDL-C/HDL-C median = 2.301. Model 1 was the crude model. Model 2 was adjusted for sex and age. Model 3 was adjusted for sex, age, body mass index, type of AMI, estimated glomerular filtration rate, heart failure, Aspirin use, Statins use, cardiac troponin I, diabetes, PCI during hospitalization and history of stroke.

Abbreviations: ApoA-1, apolipoprotein A-1; apoB, apolipoprotein B; AMI, acute myocardial infarction; REF, reference; OR, odds ratio; CI, confidence interval.

Figure 3 Spearman correlation analysis between each pair of lipid measures.

Notes: Asterisk (*) indicates whether the association between the two lipid parameters is statistically significant. The color of the squares indicates the strength of the correlation between the two lipid parameters, and darker colors represent the stronger correlation between the two, and vice versa. None*P > 0.05; ***P < 0.001.

Abbreviations: TC, total cholesterol; TG, triglyceride; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; NHDL-C, non-high-density lipoprotein cholesterol; RC, remnant cholesterol; apoA-1, apolipoprotein A-1; apoB, apolipoprotein B.