Abstract

Background: This study investigates the role of Apolipoprotein B (Apo B), Apolipoprotein A1 (Apo A1), and their ratio (Apo B/Apo A1) in predicting the severity of coronary artery lesions in Acute Coronary Syndrome (ACS). It aims to evaluate serum levels of these biomarkers and establish their cut-off values in predicting severe coronary stenosis using the Gensini score.

Methods: This single-center, cross-sectional study included 103 ACS patients who underwent coronary angiography between October 2024 and February 2025. Patients were categorized based on their Gensini scores into low (<40 points, n=64) and high (≥40 points, n=39) groups. Serum levels of Apo B, Apo A1, and lipid parameters were measured. The diagnostic value of these biomarkers in identifying severe coronary artery lesions was assessed using receiver operating characteristic (ROC) curve analysis.

Results: The high Gensini group showed significantly lower Apo A1 levels (1.11±0.19 vs. 1.29±0.24 g/L, p<0.001) and higher Apo B levels (1.13±0.39 vs. 0.93±0.28 g/L, p=0.003) compared to the low Gensini group. The Apo B/Apo A1 ratio was significantly elevated in the high Gensini group (median 1.04 vs. 0.73, p<0.001). The optimal cut-off value for the Apo B/Apo A1 ratio was 0.905, with 74.4% sensitivity and 82.8% specificity (AUC=0.758).

Conclusion: These results underscore the Apo B/Apo A1 ratio as a viable diagnostic for identifying individuals with significant coronary lesions and support the clinical relevance of apolipoprotein-based biomarkers in risk stratification of ACS.