Different Plaque Composition and Progression in Patients with Stable and Unstable Coronary Syndromes Evaluated by Cardiac CT

Integrating Computational and Biological Hemodynamic Approaches to Improve Modeling of Atherosclerotic Arteries

Atherosclerosis is the primary cause of cardiovascular disease, resulting in mortality, elevated healthcare costs, diminished productivity, and reduced quality of life for individuals and their communities. This is exacerbated by the limited understanding of its underlying causes and limitations in current therapeutic interventions, highlighting the need for sophisticated models of atherosclerosis. This review critically evaluates the computational and biological models of atherosclerosis, focusing on the study of hemodynamics in atherosclerotic coronary arteries. Computational models account for the geometrical complexities and hemodynamics of the blood vessels and stenoses, but they fail to capture the complex biological processes involved in atherosclerosis. Different in vitro and in vivo biological models can capture aspects of the biological complexity of healthy and stenosed vessels, but rarely mimic the human anatomy and physiological hemodynamics, and require significantly more time, cost, and resources. Therefore, emerging strategies are examined that integrate computational and biological models, and the potential of advances in imaging, biofabrication, and machine learning is explored in developing more effective models of atherosclerosis.

Multimodal Cardiac Imaging Revisited by Artificial Intelligence: An Innovative Way of Assessment or Just an Aid?

Cardiovascular disease remains a leading global health challenge, necessitating advanced diagnostic approaches. This review explores the integration of artificial intelligence (AI) in multimodal cardiac imaging, tracing its evolution from early X-rays to contemporary techniques such as CT, MRI, and nuclear imaging. AI, particularly machine learning and deep learning, significantly enhances cardiac diagnostics by estimating biological heart age, predicting disease risk, and optimizing heart failure management through adaptive algorithms without explicit programming or feature engineering. Key contributions include AI's transformative role in non-invasive coronary artery disease diagnosis, arrhythmia detection via wearable devices, and personalized treatment strategies. Despite substantial progress, challenges including data standardization, algorithm validation, regulatory approval, and ethical considerations must be addressed to fully harness AI's potential. Collaborative efforts among clinicians, scientists, industry stakeholders, and regulatory bodies are essential for the safe and effective deployment of AI in cardiac imaging, promising enhanced diagnostics and personalized patient care.

Using artificial intelligence to study atherosclerosis from computed tomography imaging: A state-of-the-art review of the current literature

With the enormous progress in the field of cardiovascular imaging in recent years, computed tomography (CT) has become readily available to phenotype atherosclerotic coronary artery disease. New analytical methods using artificial intelligence (AI) enable the analysis of complex phenotypic information of atherosclerotic plaques. In particular, deep learning-based approaches using convolutional neural networks (CNNs) facilitate tasks such as lesion detection, segmentation, and classification. New radiotranscriptomic techniques even capture underlying bio-histochemical processes through higher-order structural analysis of voxels on CT images. In the near future, the international large-scale Oxford Risk Factors And Non-invasive Imaging (ORFAN) study will provide a powerful platform for testing and validating prognostic AI-based models. The goal is the transition of these new approaches from research settings into a clinical workflow. In this review, we present an overview of existing AI-based techniques with focus on imaging biomarkers to determine the degree of coronary inflammation, coronary plaques, and the associated risk. Further, current limitations using AI-based approaches as well as the priorities to address these challenges will be discussed. This will pave the way for an AI-enabled risk assessment tool to detect vulnerable atherosclerotic plaques and to guide treatment strategies for patients.

Relation between Coronary Artery Calcium Score and Cardiovascular Events in Hodgkin Lymphoma Survivors: A Cross-Sectional Matched Cohort Study

BACKGROUND

Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended.

OBJECTIVES

This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group.

METHODS

Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use.

RESULTS

Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22-4.28] for having a CACS > 0 compared to the matched population (p = 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population (p = 0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively, p = 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population.

CONCLUSION

In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group.

A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

Aims

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions.

Methods

This study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion.

Results

In this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, p = 0.004) and final success (73.3 vs. 95.2%, p = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min.

Conclusions

Grouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.

Cardiac CT scanning in coronary artery disease: Epicardial fat volume and its correlation with coronary artery lesions and left ventricular function

Coronary artery disease (CAD) is a major and common disease that poses a threat to human health. Recent studies suggested that epicardial fat may have an important role in the pathogenesis of CAD. Therefore, the association between epicardial fat volume (EFV) and left ventricular function with CAD was investigated in the present study. A total of 61 patients with suspected CAD who underwent CT scanning were enrolled. Baseline data, parameters of left heart function and EFV of the subjects were collected and analyzed. The degree of coronary artery lesions was assessed using the Gensini score. Pearson's correlation analysis and a logistic regression model were applied to assess the association between EFV and risk factors for CAD, the Gensini score and left ventricular function index. A total of 29 female and 32 male subjects with a median age of 63 years were enrolled. The median body mass index (BMI) of the subjects was 23.37 kg/m² and the median EFV was 86.41 cm³. It was revealed that risk factors of CAD, specially hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction and smoking, had no significant association with the EFV (P>0.05); however, the EFV was significantly positively correlated with the BMI (r=0.479, P<0.0001), interventricular septal thickness (r=0.436, P=0.004), left ventricular posterior wall thickness (r=0.350, P=0.0058), left ventricular end diastolic diameter (r=0.265, P=0.0388), left ventricular mass (r=0.445, P=0.0003) and left ventricular mass index (r=0.371, P=0.0035). However, no correlation was identified between the EFV and the Gensini score (r=0.131, P=0.3137). In conclusion, the EFV measured by cardiac CT scanning was positively correlated with the BMI and left ventricular function, but was not associated with the presence of CAD according to the Gensini scores.

Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis: how the plaque type influences the diagnostic performance

Purpose

To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA).

Material and methods

We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a qualitative method.

Results

CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS < 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference (p < 0.001 and p = 0.007).

Conclusions

CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments.

An automatic multi-class coronary atherosclerosis plaque detection and classification framework

Detection of different classes of atherosclerotic plaques is important for early intervention of coronary artery diseases. However, previous methods focused either on the detection of a specific class of coronary plaques or on the distinction between plaques and normal arteries, neglecting the classification of different classes of plaques. Therefore, we proposed an automatic multi-class coronary atherosclerosis plaque detection and classification framework. Firstly, we retrieved the transverse cross sections along centerlines from the computed tomography angiography. Secondly, we extracted the region of interests based on coarse segmentation. Thirdly, we extracted a random radius symmetry (RRS) feature vector, which incorporates multiple descriptions into a random strategy and greatly augments the training data. Finally, we fed the RRS feature vector into the multi-class coronary plaque classifier. In experiments, we compared our proposed framework with other methods on the cross sections of Rotterdam Coronary Datasets, including 729 non-calcified plaques, 511 calcified plaques, and 546 mixed plaques. Our RRS with support vector machine outperforms the intensity feature vector and the random forest classifier, with the average precision of 92.6 ± 1.9% and average recall of 94.3 ± 2.1%. The proposed framework provides a computer-aided diagnostic method for multi-class plaque detection and classification. Graphical abstract Diagram of the proposed automatic multi-class coronary atherosclerosis plaque detection and classification framework. ᅟ.

Morphological Features and Plaque Composition in Culprit Atheromatous Plaques of Patients with Acute Coronary Syndromes

Background: The independent role of each plaque feature in relation to plaque vulnerability is still the subject of ongoing research. This study aimed to compare the morphologic characteristics of vulnerable atheromatous coronary plaques with the ones of stable, non-vulnerable plaques, and in plaques with different locations in the coronary tree, in order to identify the most relevant imaging-based biomarkers associated with coronary plaque vulnerability.

Material and methods: This was a prospective observational, non-randomized study that included 50 patients with unstable angina who underwent computed tomography angiography for assessment of the entire coronary artery tree followed by complex morphologic analysis of all lesions, divided into two groups: group 1 – 25 patients with vulnerable plaque (VP) and group 2 – 25 age- and gender-matched patients with non-vulnerable plaque (NVP).

Results: Lesions with a stenosis degree >70% were significantly longer than those with a stenosis degree <70% (8.27 ± 2.74 mm vs. 5.56 ± 4.11 mm, p = 0.04). VP presented significantly higher values of plaque thickness (p = 0.0005), plaque burden (p = 0.0004), and higher total plaque volume (p = 0.0005) than NVP. The remodeling index was not significantly different between the groups (p = 0.6), but the eccentricity index was (0.24 ± 0.14 compared to 0.14 ± 0.17, p = 0.023). Linear regression analysis revealed a significant correlation between plaque burden and plaque components in VP (r = 0.76, p <0.0001 for necrotic core; r = 0.62, p = 0.0008 for fibro-fatty tissue; and r = 0.5, p = 0.01 for fibrotic tissue volume). Culprit plaques located in the right coronary artery presented significantly larger plaque burden volumes (91.17 ± 4.88 mm3 vs. 83.35 ± 8.47 mm3, p = 0.04), larger volumes of necrotic core (82.03 ± 47.85 mm3 vs. 45.84 ± 43.72 mm3, p = 0.02) and fibrofatty tissue (53.23 ± 31.92 mm3 vs. 23.76 ± 20.90 mm3, p = 0.02) than the ones situated in the left coronary artery.

Conclusions: VPs from the culprit lesions exhibit a different phenotype than non-vulnerable ones, and vulnerability features are present in a significantly larger extent in VPs from the right coronary artery as compared to those from the left coronary artery.

Original Research. Transluminal Contrast Attenuation Gradient Is Associated with Coronary Plaque Vulnerability — a Computed Tomography Angiography-based Study

The aim of this study was to demonstrate that the transluminal contrast attenuation gradient (TAG), a new CT imaging-derived marker of functional significance of a coronary stenosis, is directly associated with the vulnerability degree of atheromatous coronary plaques. Material and methods: This is a prospective study on 21 patients with 30 atheromatous plaques in the coronary arteries, who underwent cardiac computed tomography angiography (CCTA) for assessment of coronary plaques. Results: Twelve plaques were classified as vulnerable (40%) and 18 plaques (60%) as non-vulnerable. Plaques associated with a TAG value above 10 HU exhibited in a significantly higher proportion CCTA markers of plaque vulnerability, as compared to plaques in which the attenuation gradient was below 10 HU. TAG values >10 HU were associated with a higher amount of plaque volume (107.4 ± 91.2 mm3 vs. 56.0 ± 37.5 mm3, p = 0.009), necrotic core (32.5 ± 36.9 mm3 vs. 3.1 ± 3.2 mm3, p = 0.0003), and fibro-fatty tissue (17.7 ± 16.3 mm3 vs. 4.0 ± 2.6 mm3, p = 0.0002), as compared to those lesions with TAG values below 10 HU. Linear regression analysis revealed a significant correlation between TAG values and CCTA features of plaque instability: necrotic core (r = −0.73, p <0.0001), fibrofatty tissue (r = −0.63, p = 0.0002), and plaque volume (r = −0.48, p = 0.006). Conclusions: In patients with coronary artery disease, contrast attenuation gradient along the coronary plaques, determined by CCTA, correlates with CT markers of plaque vulnerability. Vulnerable coronary plaques are associated with a higher functional significance than the stable ones with a similar anatomic profile.

Coronary Plaque Progression and Regression in Asymptomatic African American Chronic Cocaine Users With Obstructive Coronary Stenoses: A Preliminary Study

OBJECTIVE

Although rapid progression of coronary atherosclerosis was observed in chronic cocaine users, it is unknown whether reduced cocaine use retards the progression of atherosclerosis. We investigated whether reduced cocaine use over a 12-month period was associated with coronary plaque regression in cocaine users.

METHODS

Fifteen African American chronic cocaine users with previously coronary computed tomography angiography (CCTA)-confirmed >50% coronary stenosis in Baltimore, Maryland, were enrolled in a study to investigate whether reduced cocaine use is associated with changes in coronary plaque burden over a 12-month period of cash-based incentive intervention, which was implemented to systematically reinforce cocaine abstinence. In addition to previous CCTA (preintervention), CCTA was performed at the intervention baseline and at postintervention. Plaque analyses were performed to determine the trajectory of plaque changes in the absence of intervention by comparing the preintervention with the intervention baseline studies; the trajectory of plaque changes associated with the intervention by comparing the intervention baseline with the postintervention studies; and (3) whether reduced cocaine use was independently associated with changes in coronary plaque burden.

RESULTS

During the 12-month cash-based incentive intervention period, cocaine use in participants was lower. The medians of noncalcified plaque indices were 37.8 (interquartile range [IQR] 29.3-44.0), 43.1 (IQR 38.3-49.0), and 38.7 (IQR 31.2-46.8) mm at preintervention, intervention baseline, and postintervention, respectively. Multivariable generalized estimating equation analysis showed that both total plaque and noncalcified plaque indices at preintervention were significantly lowered as compared with intervention baseline levels; both total plaque and noncalcified plaque indices after intervention were significantly lowered as compared with intervention baseline levels; and reduced cocaine use was independently associated with lower total plaque volume index (P < 0.0001) and noncalcified plaque volume index (P = 0.010).

CONCLUSIONS

Our findings suggest that continued cocaine use may be associated with noncalcified plaque progression, whereas reduced cocaine use may be associated with noncalcified plaque regression. Larger studies are needed to confirm these findings.

A Comparative Preliminary Study on CT Contrast Attenuation Gradient Versus Invasive FFR in Patients with Unstable Angina

The aim of this preliminary study was to assess the effectiveness of transluminal contrast attenuation gradient (TAG) determined by computed tomographic angiography (CTA), for the evaluation of the functional significance of coronary artery stenoses in patients with acute coronary syndromes produced by vulnerable coronary plaques, and to demonstrate the correlation between this new parameter and the vulnerability markers of the culprit lesions.

Material and methods: This is a preliminary pilot study on 10 patients with acute coronary syndromes – unstable angina type, who underwent CTA for the assessment of coronary lesions, followed by invasive angiography and the determination of fractional flow reserve (FFR) prior to a revascularization procedure. Patients were divided into 2 groups, according to their FFR values: Group 1 consisted of 6 patients with an FFR value <0.8 (functionally significant lesion), and Group 2 consisted of 4 patients who presented an FFR value >0.8 (functionally non-significant lesion).

Results: FFR values were 0.64 ± 0.07, 95% CI: 0.5–0.7 in Group 1, and 0.86 ± 0.05, 95% CI: 0.7–0.9 in Group 2. Plaques associated with an FFR<0.8 presented a higher amount of plaque volume (192.7 ± 199.7 mm3 vs. 42.1 ± 27.3 mm3, p = 0.1), necrotic core (66.7 ± 72.9 mm3 vs. 10.0 ± 9.3 mm3, p = 0.1), and fibro-fatty tissue (29.7 ± 37.4 mm3 vs. 6.2 ± 3.8 mm3, p = 0.2). At the same time, TAG significantly correlated with the presence of a functionally significant lesion. Coronary lesions associated with low FFR presented significantly higher values of TAG along the plaque as compared with lesions with FFR values >0.8 (TAG values 22.1 ± 5.8 HU vs. 11.7 ± 2.5 HU, p = 0.01). Linear regression identified a significant correlation between TAG and FFR values as a measure of functional significance of the lesion (r = 0.7, p = 0.01).

Conclusions: Contrast attenuation gradient along the culprit lesion, determined by CTA, correlates with the FFR values and with CT markers of plaque vulnerability, indicating that the presence of vulnerability features inside a coronary plaque could increase the functional significance of a coronary lesion.

Association between Lp-PLA2 and coronary heart disease in Chinese patients

Objective

To evaluate the association between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2; known to release inflammatory mediators that promote atherosclerosis) and coronary heart disease (CHD) in Chinese patients.

Methods

This observational, cross-sectional study included a patient cohort who were assessed by coronary angiography and divided into patients with coronary heart disease and patients with normal coronary angiography (controls). Data for several biochemical indicators were collected. Plasma Lp-PLA2 concentrations were measured by enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression were used to analyse the association between Lp-PLA2 concentration and CHD.

Results

A total of 531 patients were included, comprising 391 with CHD and 140 with normal coronary angiography (controls). Plasma Lp-PLA2 concentration was significantly higher in patients with CHD versus controls (median, 251 µg/l versus 219 µg/l, respectively), and particularly among patients with acute myocardial infarction and stable angina pectoris (249 µg/l and 266 µg/l, respectively). Multivariate analysis showed that Lp-PLA2 ≥ 292 µg/l (upper quartile of the whole cohort) was independently associated with CHD (odds ratio 2.814, 95% confidence interval 1.519, 5.214).

Conclusion

Plasma Lp-PLA2 concentration was independently associated with CHD in Chinese patients.

Coronary Computed Tomography Angiography in Combination with Coronary Artery Calcium Scoring for the Preoperative Cardiac Evaluation of Liver Transplant Recipients

Liver transplantation is the best treatment option for early-stage hepatocellular carcinoma, liver cirrhosis, fulminant liver failure, and end-stage liver diseases. Even though advances in surgical techniques and perioperative care have improved postoperative outcomes, perioperative cardiovascular complications are a leading cause of postoperative morbidity and mortality following liver transplantation. Ischemic coronary artery disease (CAD) and cardiomyopathy are the most common cardiovascular diseases and could be negative predictors of postoperative outcomes in liver transplant recipients. Therefore, comprehensive cardiovascular evaluations are required to assess perioperative risks and prevent concomitant cardiovascular complications that would preclude good outcomes in liver transplant recipients. The two major types of cardiac computed tomography are the coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA). CCTA in combination with the CACS is a validated noninvasive alternative to coronary angiography for diagnosing and grading the severity of CAD. A CACS > 400 is associated with significant CAD and a known important predictor of posttransplant cardiovascular complications in liver transplant recipients. In this review article, we discuss the usefulness, advantages, and disadvantages of CCTA combined with CACS as a noninvasive diagnostic tool for preoperative cardiac evaluation and for maximizing the perioperative outcomes of liver transplant recipients.

Assessment of Coronary Plaque Vulnerability in Acute Coronary Syndromes using Optical Coherence Tomography and Intravascular Ultrasound. A Systematic Review

The aim of this systematic review was to analyze studies characterizing vulnerable coronary plaques using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), in order to identify the most efficient invasive technique permitting plaque characterization in patients with acute myocardial infarction.

Method: A total number of 432 studies were identified, 420 through database searching and 12 through manual searching. Eight duplicate studies were removed, leaving a total number of 424 studies to be screened. Twenty-six studies only available in Abstract-only form were excluded, resulting in 398 studies checked for eligibility. Eleven studies fulfilled the eligibility criteria and were included in this systematic analysis. Plaque vulnerability was investigated in plaques with thin cap fibroatheroma (TCFA) versus those with thick cap fibroatheroma, in ruptured coronary plaques versus non-ruptured coronary plaques, in culprit versus non-culprit lesions and in lipid-rich versus non-lipid-rich plaques.

Results: A total of 1,568 coronary plaques in 1,225 patients with acute coronary syndromes (ACS) who underwent both IVUS and OCT for analysis of plaque features were included in the final analysis. The review identified the following IVUS-derived features as significantly correlated with plaque vulnerability: plaque burden (p <0.001), remodeling index (p <0.001), external elastic membrane cross-sectional area (p <0.001), and the amount of necrotic core (p <0.001), while OCT-derived features characterizing unstable plaque were TCFA (p <0.001), lipid arch (p <0.001), accumulation of macrophages (p = 0.03), and presence of intracoronary thrombus (p <0.001).

Conclusion: Both IVUS and OCT are invasive imaging techniques able to provide relevant information on the vulnerability of coronary atheromatous plaques, identifying, as they do, various plaque features significantly associated with unstable plaques. Information provided by the two techniques is complementary, and both methods can serve as a useful clinical diagnostic tool, especially in cases of ACS patients undergoing a revascularization procedure.

Contribution of various lipid profile parameters in determining creatine kinase-MB levels in unstable angina patients

Context:

In India, the correlation of severity of minor myocardial damage with dyslipidemia has rarely been studied in patients of unstable angina (UA). Dyslipidemia is proven to be a major risk factor for developing acute coronary syndrome (ACS) but still there is doubt about the type of lipoproteins involved in causing minor myocardial damage occurring in UA patients of ACS.

Aims:

The aim of our study was to find out the contribution of various types of lipoproteins to predict the severity of minor myocardial damage occurring in the patients of UA.

Settings and Design:

Correlation design was used for the study. A single group of individuals was selected. Data were collected on dependent variable creatine kinase-MB (CK-MB) and independent variables (lipid profile parameters).

Subjects and Methods:

The study comprised fifty patients admitted in cardiac care unit with typical history of UA with electrocardiogram showing no ST-segment elevation. The severity of myocardial damage was assessed from on admission CK-MB levels. The lipid profile was estimated from fasting blood samples of all the patients.

Statistical Analysis Used:

For the purpose of the study, Pearson correlation and multiple linear regression analysis methods were applied.

Results:

The triacylglycerol (TAG), very-low-density lipoprotein (VLDL), total cholesterol/high-density lipoprotein (TC/HDL) showed significant positive correlation whereas HDL was negatively correlating with CK-MB levels.

Conclusions:

The TAG, VLDL, and TC/HDL were found to be significantly affecting the severity of myocardial damage in the patients of UA.