Irene Lang, MD, Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 46140, Fax: +43 1 40400 42160, E-mail:
Thromb Haemost. 2015 Jul;114(1):133-8. doi: 10.1160/TH14-10-0834. Epub 2015 Apr 2.
Oxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro-oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutaneous coronary intervention for STE-ACS. Patients were stratified as by a pro-oxidant serum HDL oxidant index (HOI≥ 1) or with an antioxidant serum HOI (HOL< 1) capacity. Multivariate regression analysis was used to relate HOI to survival. The median follow-up time was 23 months (IQR 14.4-40.0 months). Pro-oxidant HDL was observed in 44.1 % of STE-ACS patients and was independently associated with all-cause mortality with a hazard ratio of 3.30(95 %CI 1.50-7.27, p = 0.003). Mortality rates were higher in patients with baseline pro-oxidant HDL compared to patients with preserved HDL function at 30 days (11.9 % vs 2.2 %, p=0.002), and at 4 years (22.9 % vs 8.7 %, p=0.002). Elevated neutrophil counts were a strong and independent predictor for pro-oxidant HDL with an odds ratio per standard deviation of 1.50 (95 %CI 1.11-2.03, p=0.008), as was history of prior acute myocardial infarction, elevated triglycerides levels and reduced glomerular filtration rate. In conclusion, pro-oxidant HDL represents a strong and independent predictor of long-term as well as short-term all-cause mortality in STE-ACS patients. Elevated neutrophil counts predicted the presence of serum pro-oxidant HDL. The maintenance of HDL functions might be a promising therapeutic target in STE-ACS patients.
氧化应激会影响 ST 段抬高型急性冠状动脉综合征（STE-ACS）患者的临床转归。尽管高密度脂蛋白（HDL）颗粒通常被认为具有保护作用，但在急性心肌梗死患者中已观察到 HDL 的有害特性。在这里，我们分析了促氧化剂 HDL 与 STE-ACS 患者全因死亡率之间的关系。我们在 247 例接受 STE-ACS 患者行直接经皮冠状动脉介入治疗的前瞻性入组患者中测定了 HDL 的抗氧化功能。根据促氧化剂血清 HDL 氧化剂指数（HOI≥1）或抗氧化血清 HOI（HOL<1）能力，将患者分层。使用多变量回归分析将 HOI 与生存相关联。中位随访时间为 23 个月（IQR 14.4-40.0 个月）。在 44.1%的 STE-ACS 患者中观察到促氧化剂 HDL，其与全因死亡率独立相关，风险比为 3.30（95%CI 1.50-7.27，p=0.003）。与基线时具有保留 HDL 功能的患者相比，基线时具有促氧化剂 HDL 的患者死亡率更高，30 天时为 11.9% vs 2.2%（p=0.002），4 年时为 22.9% vs 8.7%（p=0.002）。中性粒细胞计数升高是促氧化剂 HDL 的一个强烈且独立的预测因子，每标准差的优势比为 1.50（95%CI 1.11-2.03，p=0.008），同时也是既往急性心肌梗死、甘油三酯水平升高和肾小球滤过率降低的一个预测因子。总之，促氧化剂 HDL 是 STE-ACS 患者长期和短期全因死亡率的一个强有力且独立的预测因子。中性粒细胞计数升高预测血清促氧化剂 HDL 的存在。维持 HDL 功能可能是 STE-ACS 患者有希望的治疗靶点。
