Correlation between Serum CitH3 and Coronary Artery Disease Severity and Slow Blood Flow in Patients with Non-ST-segment Elevation Acute Coronary Syndrome

YANG Haitao; QIU Liangxian; WANG Guan

doi:10.12102/j.issn.1672-1349.2025.04.016

Abstract：Objective: To investigate the correlation between serum citrullinated histone H3 (CitH3) and the severity of coronary artery lesions and slow flow in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 242 NSTE-ACS patients who underwent percutaneous coronary intervention (PCI) at the Department of Cardiology, Peking University Shenzhen Hospital from January 2020 to June 2022 were selected as the study group (NSTE-ACS group), along with 63 individuals with normal coronary angiography as the control group. According to the SYNTAX score from coronary angiography, NSTE-ACS patients were divided into high-risk group (≥33 points, 65 cases), intermediate-risk group (23–32 points, 102 cases), and low-risk group (≤22 points, 75 cases). According to whether slow flow occurred after PCI, they were further divided into slow flow group (51 cases) and non-slow flow group (191 cases). Serum CitH3 levels were measured before the procedure. Pearson correlation analysis was used to analyze the correlation between CitH3 and SYNTAX score. Multivariate logistic regression analysis was performed to identify factors influencing the occurrence of slow flow after PCI in NSTE-ACS patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CitH3 for slow flow after PCI in NSTE-ACS patients. Results: Serum CitH3 levels in the NSTE-ACS group were higher than those in the control group (P < 0.05). Serum CitH3 levels in the high-risk group were higher than those in the intermediate-risk and low-risk groups (P < 0.05), and the intermediate-risk group had higher levels than the low-risk group (P < 0.05). Serum CitH3 levels in the NSTE-ACS group were positively correlated with SYNTAX scores (r = 0.578, P < 0.05). High shock index, high SYNTAX score, and high CitH3 were risk factors for slow flow after PCI in NSTE-ACS patients (P < 0.05). The area under the ROC curve for CitH3 in predicting slow flow after PCI in NSTE-ACS patients was 0.753 [95% CI (0.694, 0.806)], with a sensitivity of 78.43% and specificity of 72.77%. Conclusion: Serum CitH3 levels are elevated in NSTE-ACS patients and are associated with the progression of coronary artery lesions and slow flow after PCI. Measuring CitH3 may help assess the risk of slow flow after PCI.