Abstract:Objective To explore the predictive value of lipoprotein a [Lp(a)] combined with monocyte to high-density lipoprotein cholesterol ratio (MHR) for coronary artery lesions severity and prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods A total of 310 NSTE-ACS patients admitted to the First Affiliated Hospital of Anhui Medical University from March 2020 to March 2021 were enrolled. Taking the third quartile of Gensini score (Q_U=38) as the cut-off point according to coronary angiography, the patients were divided into high-risk (Q_U≥38, n=74) group and non high-risk (Q_U＜38, n=236) group. Logistic regression was used to analyze the associations of Lp (a) and MHR with the severity of coronary artery lesions, and ROC curve was used to evaluate the value of Lp (a) combined with MHR in determining the severity and prognosis of coronary artery lesions. Results There were no significant differences in general clinical data between two groups, including gender, smoking history, incidences of hypertension, diabetes, hypercholesterolemia,renal insufficiency and statins using (P＞0.05), however, the age, blood Lp (a) level and MHR in high-risk group were significantly higher than those in non high-risk group (P＜0.01). Spearman correlation analysis found that Lp(a) and MHR were positively correlated with Gensini scores, respectively (r=0.316, P＜0.05; r=0.715,P＜0.05). Multivariate binary Logistic regression analysis showed that the Lp (a) level, age and MHR were independent risk factors for coronary high-risk lesions (P＜0.01,P＜0.05). In evaluating high-risk coronary lesions, ROC curve analysis showed that AUC of Lp (a) with MHR (0.854) was greater than those of Lp (a) and MHR alone (0.852,0.754), respectively. The sensitivity of joint evaluation ［Lp (a) and MHR］ was 73.0% and was higher than 55.6% of Lp (a) alone, but it was lower than 82.4% of MHR. The specificity of joint evaluation was 85.6% and was respectively higher than that of Lp (a) and MHR alone (84.1%, 61.9%). In evaluating poor prognosis of NSTE-ACS patients, ROC curve analysis showed that AUC of the combined detection of Lp(a) and MHR was 0.800 and was respectively greater than that of Lp(a) (0.781) and MHR (0.739). The sensitivity of Lp(a) combined with MHR was 72.2% and was higher than 66.7% of Lp(a) and 66.7% of MHR alone. The specificity of combined detection of Lp(a) and MHR was 81.9% and was higher than 80.9% of MHR, but was lower than 84.8% of Lp(a). Conclusion Abnormally elevated blood Lp (a) level combined with MHR has a high value in judging the severity of coronary artery lesions and poor prognosis in patients with NSTE-ACS.