低血清甘油三酯水平是接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者院内及晚期主要不良事件的危险因素——一项队列研究。
Lower serum triglyceride level is a risk factor for in-hospital and late major adverse events in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention- a cohort study.
作者信息
Cheng Yu-Tsung, Liu Tsun-Jui, Lai Hui-Chin, Lee Wen-Lieng, Ho Hung-Yun, Su Chieh-Shou, Liu Chia-Ning, Wang Kuo-Yang
机构信息
Cardiovascular Center and Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
BMC Cardiovasc Disord. 2014 Oct 10;14:143. doi: 10.1186/1471-2261-14-143.
BACKGROUND
Whether serum triglyceride level correlates with clinical outcomes of patients with ST segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI) remains unclear.
METHODS
From June 2008 to February 2012, all patients with STEMI who were treated with pPCI in this tertiary referral hospital and then had fasting lipid profiles measured within 24 hours were included and dichotomized into lower- (≦ 150 mg/dl) and higher-triglyceridemic (>150 mg/dl) groups. Baseline characteristics, in-hospital outcomes, and late major adverse cardiovascular events (MACE) were compared in-between. Independent predictors for in-hospital death and late adverse events were identified by multivariate logistic and Cox regression analyses.
RESULTS
A total of 247 patients were enrolled, including 163 lower-triglyceridemic and 84 higher-triglyceridemic subjects. The angiographic characteristics, pPCI results and in-hospital outcomes were similar between the two groups. However, multivariate logistic analysis identified triglyceride level as a negative predictor for in-hospital death (OR 0.963, 95% CI 0.931-0.995, p = 0.023). At follow-up for a mean period of 1.23 to 1.40 years, compared with the high-triglyceridemic group, low-triglyceridemic patients had fewer cumulative incidences of target vessel revascularization (TVR) (21.7% vs. 9.5%, p = 0.011) and overall MACE (26.1% vs. 11.9%, p = 0.0137). Cox regression analysis confirmed serum triglyceride as a negative predictor for TVR and overall MACE.
CONCLUSIONS
Serum triglyceride level inversely correlates with in-hospital death and late outcomes in patients with STEMI treated with pPCI. Thus, when managing such patients, a high serum triglyceride level can be regarded as a benign factor but not a target for aggressive therapy.
背景
ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（pPCI）后，血清甘油三酯水平与临床结局之间的相关性仍不明确。
方法
2008年6月至2012年2月，在这家三级转诊医院接受pPCI治疗且在24小时内测量了空腹血脂谱的所有STEMI患者被纳入研究，并分为低甘油三酯组（≤150mg/dl）和高甘油三酯组（>150mg/dl）。比较两组患者的基线特征、院内结局和晚期主要不良心血管事件（MACE）。通过多因素逻辑回归和Cox回归分析确定院内死亡和晚期不良事件的独立预测因素。
结果
共纳入247例患者，其中低甘油三酯组163例，高甘油三酯组84例。两组患者的血管造影特征、pPCI结果和院内结局相似。然而，多因素逻辑回归分析确定甘油三酯水平是院内死亡的负性预测因素（OR 0.963，95%CI 0.931-0.995，p = 0.023）。在平均1.23至1.40年的随访期内，与高甘油三酯组相比，低甘油三酯组患者的靶血管血运重建（TVR）累积发生率较低（21.7%对9.5%，p = 0.011），总体MACE发生率也较低（26.1%对11.9%，p = 0.0137）。Cox回归分析证实血清甘油三酯是TVR和总体MACE的负性预测因素。
结论
STEMI患者接受pPCI治疗后，血清甘油三酯水平与院内死亡和晚期结局呈负相关。因此，在管理此类患者时，高血清甘油三酯水平可被视为一个良性因素，而非积极治疗的靶点。
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