Study on the relationship between plasma ANGPTL3,ANGPTL8,coronary artery lesions,and major adverse cardiovascular events after PCI in patients with ACS complicated by T2DM

Yang Yanjie; Li Cong; Duan Lijun; Zhang Jing

doi:10.3969/j.issn.1671-6450.2025.03.001

Abstract：Objective To explore the relationship between plasma angiopoietin-like(ANGPTL)3,ANGPTL8,coro-nary artery lesions,and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in pa-tients with acute coronary syndrome(ACS)complicated by type 2 diabetes mellitus(T2DM).Methods A total of 200 pa-tients with ACS complicated by T2DM(comorbidity group)and 100 patients with pure ACS(pure ACS group)were selected from the Emergency Department of Beijing Tongren Hospital,Capital Medical University,from January 2021 to June 2023.Additionally,100 healthy volunteers were selected as the healthy control group.According to the severity of coronary artery lesions,the ACS complicated by T2DM patients were divided into mild(62 cases),moderate(80 cases),and severe(58 cases)subgroups.Based on whether MACE occurred one year after PCI,the patients were divided into the MACE sub-group(71 cases)and the non-MACE subgroup(129 cases).The levels of plasma ANGPTL3 and ANGPTL8 were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to analyze the influencing fac-tors of MACE in ACS complicated by T2DM after PCI.The receiver operating characteristic(ROC)curve was used to ana-lyze the predictive value of plasma ANGPTL3 and ANGPTL8 levels for MACE after PCI.Results Plasma levels of ANGPTL3 and ANGPTL8 in the comorbidity group were higher than those in the pure ACS group,which were higher than those in the healthy control group(F/P=225.251/＜0.001,166.309/＜0.001).Plasma levels of ANGPTL3 and ANGPTL8 in-creased sequentially from mild to moderate to severe subgroups(F/P=410.079/＜0.001,390.246/＜0.001).Plasma ANGPTL3 and ANGPTL8 levels in ACS complicated by T2DM were positively correlated with the Gensini score(rs/P=0.803/＜0.001,0.814/＜0.001).Compared with non-MACE subgroup,cTnI,CK-MB,HbA1c,ANGPTL3,ANGPTL8 and Gensini score were in-creased in MACE subgroup(t/P=2.720/0.007,3.005/0.003,3.790/＜0.001,7.914/＜0.001,8.249/＜0.001,7.048/＜0.001).Multivari-able Logistic regression analysis showed that increased Gensini score,elevated ANGPTL3,and elevated ANGPTL8 were in-dependent risk factors for MACE after PCI in ACS complicated by T2DM[OR(95％CI)=1.053(1.030-1.077),1.244(1.120-1.381),1.017(1.010-1.024)].The area under the curve(AUC)for predicting MACE after PCI in ACS complicated by T2DM using plasma ANGPTL3,ANGPTL8,and their combination were 0.780,0.790,and 0.886,respectively.The combined use of ANGPTL3 and ANGPTL8 was superior to each individual prediction(Z/P=3.638/＜0.001,3.756/＜0.001).Conclusion Ele-vated plasma ANGPTL3 and ANGPTL8 levels in ACS complicated by T2DM are associated with increased coronary artery lesions and the occurrence of MACE after PCI.The combination of ANGPTL3 and ANGPTL8 has a high predictive value for MACE after PCI.