Association of Serum Anion Gap and Angiographic Severity of Coronary Artery Disease by Gensini Score in Patients with Acute Coronary Syndrome

Abstract

Background: The serum anion gap (AG) has been reported to have an association with the severity of coronary artery diseases (CAD). This association is not yet well studied in Bangladesh. Gensini  Score (GS) gives insight into the severity of CAD. Acute Coronary Syndrome is a severe type of
coronary artery disease. The study of severity of CAD by GS in relation to AG following acute coronary syndrome (ACS) remains limited in Bangladesh.

Methods: This cross-sectional analytical study was conducted at the department of Cardiology, Sir Salimullah Medical College Mitford Hospital, Dhaka, for a duration of 12-months following ethical approval. A total of 90 patients with Acute Coronary Syndrome (ACS) who underwent coronary
angiography were included after getting written informed consent. 45 patients were included in group A (anion gap 8 mEq/L to 16 mEq/L) and 45 patients were in group B (anion gap >16 mEq/L). Data were collected on pre designed data collection sheet separated case-record form and  analyzed by SPSS-26.

Results: Mean age of the patients in Group A and Group B was 59.5±11.9 years and 64.9±9.1 years accordingly. Age was significantly higher in Group B than Group A. Among all, 53.3% of the patients had Gensini score ≥50, 46.7% had Gensini score <50. Mean Gensini score in Group A and Group B was 43.9±6.3 and 54.8±1.4 accordingly. Mean Gensini score was significantly higher among the patients with anion gap above 16mEq/L. A cut off value Anion gap>16 mEq/L (AUC=0.899, 95% CI=0.831-0.967, p<0.001) in the prediction of severe CAD (Gensini score ≥50) showed 81.25% sensitivity, 80.95% Specificity, 82.98% PPV, 79.07% NPV and 81.11% accuracy.

Conclusion: This study investigated the association of serum anion gap and the severity of coronary artery disease as measured by Gensini Score (GS) in patients with acute coronary syndrome (ACS). A higher anion gap levels (>16 mEq/L) were associated with increased severity of CAD by Gensini scores in patients with ACS.

J Inv Clin Cardiol 2024; 6(2): 65-78