Proprotein convertase subtilisin/kexin type 9 (Pcsk9) correlated with incidence and prognosis of coronary heart disease. However, it is unclear whether Pcsk9 contributed to coronary artery lesion severity in patients with premature myocardial infarction (PMI). The present study investigated associations between Pcsk9 and coronary artery lesion severity in PMI patients who underwent coronary angiography (CAG). This prospective cohort study included young men (age ≤ 45 years, n = 332) with acute MI who underwent CAG between January 2017 and July 2019. Serum Pcsk9 levels and clinical characteristics were evaluated. SYNTAX scores (SYNergy between percutaneous coronary intervention with [paclitaxel-eluting] TAXUS stent and cardiac surgery) were calculated to quantify coronary artery lesions. Serum Pcsk9 levels were positively associated with SYNTAX scores (r = 0.173, P < 0.05). The diagnostic cutoff value of PSCK9 level was 122.9 ng/mL, yielding an area under the curve (AUC) of 0.63, sensitivity 81%, and specificity 40%. Serum Pcsk9, LDL-C, Apob, NT-proBnp, CK level, and diabetes history were independent predictors of high SYNTAX scores (P < 0.05). After stratifying by serum LDL-C level (cutoff = 2.6 mmol/L), medium-high Pcsk9 levels had increased risk of high SYNTAX scores in patients with high LDL-C (P < 0.05), and higher serum Pcsk9 levels had increased risk of major adverse cardiac events (MACE) after adjusting for confounding factors (P < 0.05). Serum Pcsk9 levels correlates with severity of coronary artery lesion in PMI patients and may serve as a biomarker for severity of coronary artery stenosis in this patient population, which may contribute to risk stratification.

中文翻译：

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Pcsk9与男性早发性心肌梗死患者冠状动脉病变的严重程度相关

Proprotein convertase subtilisin/kexin type 9 (Pcsk9) 与冠心病的发病率和预后相关。然而，尚不清楚 Pcsk9 是否会导致早发性心肌梗死 (PMI) 患者的冠状动脉病变严重程度。本研究调查了 Pcsk9 与接受冠状动脉造影 (CAG) 的 PMI 患者冠状动脉病变严重程度之间的关联。这项前瞻性队列研究包括在 2017 年 1 月至 2019 年 7 月期间接受 CAG 的急性 MI 年轻男性（年龄 ≤ 45 岁，n = 332）。评估了血清 Pcsk9 水平和临床特征。计算 SYNTAX 评分（经皮冠状动脉介入治疗 [紫杉醇洗脱] TAXUS 支架与心脏手术之间的协同作用）以量化冠状动脉病变。血清 Pcsk9 水平与 SYNTAX 评分呈正相关（r = 0.173，P < 0.05）。PSCK9 水平的诊断临界值为 122.9 ng/mL，曲线下面积 (AUC) 为 0.63，敏感性为 81%，特异性为 40%。血清 Pcsk9、LDL-C、Apob、NT-proBnp、CK 水平和糖尿病史是高 SYNTAX 评分的独立预测因子（P < 0.05）。根据血清 LDL-C 水平（临界值 = 2.6 mmol/L）分层后，中高 Pcsk9 水平增加了高 LDL-C 患者出现高 SYNTAX 评分的风险（P < 0.05），较高的血清 Pcsk9 水平增加了风险调整混杂因素后的主要不良心脏事件 (MACE) (P < 0.05)。