الفهرس 
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Abstract
Coronary artery disease is a leading cause of death and disability worldwide. Despite scientific advances in the area, the exact mechanism underlying the pathophysiology of atherosclerosis remains unclear. In the majority of cases, the underlying cause of CAD is atherosclerosis, which is a chronic inflammatory disease of an unknown cause. Despite advances in our understanding of the pathophysiology of coronary disease and improvements in its management and prevention, acute coronary syndromes remain a major cause of mortality and morbidity in industrialized countries and are becoming an increasingly important problem in developing countries. The relationship between the serum HDL-C level and atherosclerosis has been known for a long time. Reduced levels of HDL-C are associated with an increased risk for coronary artery disease and future cardiovascular events. At least some of these anti-atherogenic effects of HDL-C may be due to its anti-inflammatory and antioxidant properties, which shows that the anti-inflammatory and antioxidant properties of HDL-C remain unquestionable in previous studies. The RDW has been reported to be a predictor of coronary heart disease events in different cardiovascular conditions and of all-cause mortality. The RDW was also found to be a strong independent predictor of all-cause mortality in the ACS subset of patients based on a multivariate analysis. chronic subclinical inflammation appears to be a potential pathophysiologic mechanism underlying the association between the RDW and CAD and other cardiovascular events. Inflammation leads to anisocytosis due to the release of immature red blood cells into the peripheral circulation. Another mechanism suggested to underlie the association between the RDW and an increased frequency of CAD events is oxidative stress. High oxidative stress has been shown to be associated with an increased risk of cardiovascular events. Additionally, high oxidative stress reduces red blood cell survival, causes anisocytosis and promotes the release of premature red blood cells into the peripheral circulation. The aim of this study was to investigate whether there is a relationship between HDL-C, which has anti-inflammatory properties, and the RDW, which suggests underlying inflammation in patients presenting with ACS. This study included 100 participants, their ages ranged between 30 to 74 Years with a mean of 54.48 ±8.76 years, with ACS referred for coronary angiography. The nature of the study was explained to all participants. An informed verbal consent was taken from all participants in the research and the privacy of the data was greatly considered. All patients were subjected to clinical assessment detailed history and clinical examination were performed with special emphasis on: 1- 12-leads ECG was done for detection of coronary artery disease or any ischemic changes and for exclusion of arrhythmia. 2- Risk factors for cardiovascular diseases as systemic hypertension, diabetes mellitus and smoking.. 3- Echocardiography. 4- Coronary angiography. 5- Serum HDL-C level was measured after at least an 8-h fasting blood sample. 6- The RDW was obtained from a hemogram. On complete blood count. The patients in this study were divided into 2 groups according to the clinical presentation, the first group was STEMI group which included 84 patients and the second group was NSTEMI group which include 16 patients and then were compared to each other according to gender of patients, age of patients, risk factors of CAD as HTN, DM, smoking, dyslipidaemia, ejection fraction (EF), wall motion score index (WMSI) and the relationship between RDW and HDL-C. The study showed the following results: - • The clinical presentation of ACS in relation to different ages of the patients showed no statistically significant difference between the STEMI and NSTEMI groups with P-value (0.809). • There was no significant difference between the two groups as regard gender with P-value (0.0564). and there was no significant difference between the two groups as regard HTN, DM, smoking and family history of CAD. • There was significant difference between the two groups as regard RDW and HDL with P-value (0.045) and (0.042) respectively. and there was no significant difference between the two groups as regard serum cholesterol, LDL, serum creatinine and Hb with P-value (0.841), (0.658), (0.388) and (0.197) respectively. • There was no significant difference between the two groups as regard EF and WMSI with P-value (0.577) and (0.242) respectively. • There was significant inverse relation between RDW and HDL-C in both groups and in all patients with ACS with P-value (0.0001)