Endo Akihiro, Yoshida Yasuyuki, Kageshima Kenji, Sato Hirotomo, Suga Toshimitsu, Nasu Hiroshi, Takahashi Nobuyuki, Tanabe Kazuaki
Division of Cardiology, Shimane University Faculty of Medicine, Japan.
Intern Med. 2014;53(8):819-28. doi: 10.2169/internalmedicine.53.1438. Epub 2014 Apr 15.
The low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio is considered to be a sensitive marker of the risk of atherosclerotic cardiovascular disease; however, in patients with a previous history of percutaneous coronary intervention (PCI), there is little information regarding the predictive value of this parameter beyond the period of early restenosis. The aim of this study was to investigate contributing factors to newly developed coronary artery disease in patients with a previous history of PCI after stabilization.
The clinical characteristics of 238 patients with a previous history of PCI who underwent coronary angiography following recurrent cardiac ischemia beyond the period of early restenosis were examined.
Overall, 64% of the patients underwent late revascularization, while 31% and 50% underwent late target lesion revascularization and new lesion revascularization, respectively. A multivariate analysis identified the LDL-C/HDL-C ratio to be an independent contributor to late revascularization (hazard ratio (HR), 1.37; p<0.001). Similarly, the independent contributors to late target lesion revascularization and new lesion revascularization were the non-HDL-C level and LDL-C/HDL-C ratio, respectively. Based on the median value of the LDL-C/HDL-C ratio, the patients were classified into high and low LDL-C/HDL-C ratio groups. The log-rank test revealed a significantly higher incidence of late revascularization in the high-LDL-C/HDL-C ratio group than in the low-LDL-C/HDL-C ratio group among the patients with an LDL-C level of ≥ 100 mg/dL (p=0.011). However, the difference between the two groups was diminished among the patients with an LDL-C level of <100 mg/dL (p=0.047), and only diabetes mellitus (HR, 2.239; p=0.009) was found to be an independent contributor to late coronary revascularization in these patients.
The LDL-C/HDL-C ratio is an important contributor to the development of new coronary artery disease in patients with a previous history of PCI beyond the period of early restenosis, particularly among patients with an LDL-C level of ≥ 100 mg/dL.
低密度脂蛋白胆固醇（LDL-C）/高密度脂蛋白胆固醇（HDL-C）比值被认为是动脉粥样硬化性心血管疾病风险的敏感标志物；然而，对于有经皮冠状动脉介入治疗（PCI）既往史的患者，关于该参数在早期再狭窄期之后的预测价值的信息很少。本研究的目的是调查PCI既往史患者在病情稳定后新发冠状动脉疾病的相关因素。
对238例有PCI既往史且在早期再狭窄期之后因复发性心脏缺血接受冠状动脉造影的患者的临床特征进行了检查。
总体而言，64%的患者接受了晚期血运重建，而分别有31%和50%的患者接受了晚期靶病变血运重建和新病变血运重建。多因素分析确定LDL-C/HDL-C比值是晚期血运重建的独立影响因素（风险比[HR]，1.37；p<0.001）。同样，晚期靶病变血运重建和新病变血运重建的独立影响因素分别是非HDL-C水平和LDL-C/HDL-C比值。根据LDL-C/HDL-C比值的中位数，将患者分为LDL-C/HDL-C比值高组和低组。对数秩检验显示，在LDL-C水平≥100mg/dL的患者中，高LDL-C/HDL-C比值组的晚期血运重建发生率显著高于低LDL-C/HDL-C比值组（p=0.011）。然而，在LDL-C水平<100mg/dL的患者中，两组之间的差异减小（p=0.047），并且仅发现糖尿病（HR，2.239；p=0.009）是这些患者晚期冠状动脉血运重建的独立影响因素。
LDL-C/HDL-C比值是有PCI既往史的患者在早期再狭窄期之后新发冠状动脉疾病的重要影响因素，尤其是在LDL-C水平≥100mg/dL的患者中。
