Acute coronary syndrome (ACS) represents a common cardiovascular disease that poses a significant threat to human health, with severe coronary artery lesions and myocardial fibrosis affecting patient prognosis. The use of non-invasive serological markers to assess the severity of coronary artery lesions and myocardial fibrosis can aid in the early risk stratification and management of ACS patients.

This study aimed to explore the relationship between serum levels of complement C1q/tumor necrosis factor-related protein-5 (CTRP5) and the severity of coronary artery lesions, as well as myocardial fibrosis markers in ACS patients, to provide guidance for the clinical assessment of coronary artery lesion severity and myocardial fibrosis.

A total of 184 patients with obstructive stenosis admitted to the Department of Cardiology, Hengshui People's Hospital from February 2021 to February 2022 were selected, along with 100 ACS patients without significant obstructive stenosis undergoing coronary angiography in the same period as controls. General patient data were collected, Doppler echocardiograms were performed, and serum levels of CTRP5, procollagen type Ⅰ (PC Ⅰ), and procollagen type Ⅲ (PC Ⅲ) were measured. The patients with obstructive stenosis were divided into unstable angina (UA) group (n=67), ST-segment elevation myocardial infarction (STEMI) group (n=57), and non-ST-segment elevation myocardial infarction (NSTEMI) group (n=61) ; based on the number of coronary artery lesions, they were categorized into single-vessel disease group (n=42), double-vessel disease group (n=69), and triple-vessel disease group (n=73). According to the SYNTAXⅡ score, they were classified into low-risk (n=77), intermediate-risk (n=73), and high-risk (n=34) groups. Based on the median levels of PCⅠ, patients were divided into low PCⅠ level group (n=95) and high PC I level group (n=89) ; similarly, based on PCⅢ median levels, into low PCⅢ level group (n=93) and high PCⅢ level group (n=91). Multiuariate Logistic regression analysis was used to explore the influencing factors of coronary artery lesion severity. Receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic value of serum CTRP5 for coronary artery lesion severity.

In ACS patients, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, fasting blood glucose (FBG), high-sensitivity cardiac troponin Ⅰ, serum CTRP5, hypersensitive C-reactive protein (hs-CRP), PC Ⅰ, and PC Ⅲ levels were higher than in control patients (P<0.05). Serum CTRP5 and hs-CRP levels in the NSTEMI and STEMI groups were higher than in the UA group (P<0.05). The triple-vessel disease group had higher serum CTRP5, PC Ⅰ, PC Ⅲ, and hs-CRP levels than the single-vessel and double-vessel disease groups (P<0.05). High-risk group patients had higher serum CTRP5, PCⅠ, PCⅢ, and hs-CRP levels compared to low-risk and intermediate-risk groups (P<0.05). The high PC I level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅰ level group (P<0.05). The high PC Ⅲ level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅲ level group (P<0.05). Multivariate Logistic regression analysis showed that increased levels of FBG, hs-CRP, and CTRP5 were risk factors for multivessel coronary artery disease (P<0.05). The areas under the ROC curve (AUC) for predicting multivessel coronary artery disease by serum CTRP5, hs-CRP, and FBG were 0.736 (95%CI=0.678-0.794), 0.687 (95%CI=0.625-0.748), and 0.649 (95%CI=0.585-0.713), respectively.

Serum CTRP5 levels have good predictive value for the severity of coronary artery lesions in ACS patients, and elevated levels of CTRP5 are potentially associated with the occurrence of myocardial fibrosis.