Study on the correlation between the plasma level of glutathione peroxidase 4 and clinical characteristics, risk stratification and prognosis of patients with acute coronary syndrome

ObjectiveTo explore the correlation between the plasma level of glutathione peroxidase 4(GPX4) and clinical characteristics, risk stratification and prognosis of patients with acute coronary syndrome(ACS).

MethodsA total of 404 patients scheduled by coronary angiography were divided into the ACS group(n=316) and control group(n=88) according to the medical history, biochemical examination, results of imaging examination and coronary angiography.The ACS group was subdivided into the unstable angina pectoris group(UAP group, n=261) and acute myocardial infarction group(AMI group, n=55).According to TIMI risk stratification, the ACS patients were divided into the high-risk group(n=36), medium-risk group(n=227) and low-risk group(n=53).The plasma levels of GPX4 in all cases were determined by enzyme linked immunosorbent assay.The ACS group was followed up for an average of 21 months after discharge for major adverse cardiovascular events(MACEs), 4 cases were lost to follow-up, and the other patients were divided into the MACEs group(n=30) and non-MACEs group(n=282).The ACS group were divided into the GPX4≥101.90 ng/mL group(n=158) and GPX4 < 101.90 ng/mL group(n=158) according to the median GPX4 level of pateints.

ResultsThe serum levels of GPX4 in ACS group were lower than that in control group(P < 0.05).The results of ROC curve showed that serum level of GPX4 could assist the diagnosis of ACS.The area under curve(AUC) was 0.828(0.778-0.878), the optimal cut-off value was 128.78 ng/mL, the specificity was 64.8%, and the sensitivity was 90.0%.In TIMI risk stratification, the serum level of GPX4 in low-risk group was higher than that in high-risk and medium-risk groups(P < 0.05).The results of ROC curve showed that the serum level of GPX4 could assist in determining whether ACS patients were in low-risk state in TIMI risk stratification, and the AUC was 0.665(0.577-0.754).The optimal cut-off value was 127.06 ng/mL, the sensitivity was 37.7%, and the specificity was 95.0%(P < 0.05).The level of GPX4 in MACEs group was lower than that in non-MACEs group(P < 0.05).There was no statistical significance in the survival time between GPX4 < 101.90 ng/mL group and GPX4≥101.90 ng/mL group in Kaplan-Meier curve.The serum level of GPX4 increasing was a protective factor for MACEs(P < 0.05).

ConclusionsThe serum level of GPX4 has reference value in the clinical diagnosis, TIMI risk stratification and long-term prognosis of ACS patients.