非高密度脂蛋白胆固醇可预测ST段抬高型心肌梗死患者的非致死性复发性心肌梗死。
Non-high-density lipoprotein cholesterol predicts nonfatal recurrent myocardial infarction in patients with ST segment elevation myocardial infarction.
作者信息
Gao Ming, Zheng Yang, Zhang Weihua, Cheng Yi, Wang Lin, Qin Ling
机构信息
The Cardiovascular Center, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China.
Laboratory for Cardiovascular Diseases, Institute of Translational Medicine, Changchun, China.
出版信息
Lipids Health Dis. 2017 Jan 23;16(1):20. doi: 10.1186/s12944-017-0418-5.
BACKGROUND
Lipids, which are associated with atherogenesis, clotting, and the fibrinolytic pathway, may be important prognostic indicators of recurrent myocardial infarction. The aim of this study was to determine the predictive value of baseline lipid fractions for nonfatal recurrent myocardial infarction in patients with ST segment elevation myocardial infarction 2 years after primary percutaneous coronary intervention in China.
METHODS
Cox proportional-hazards models were used to evaluate the association between potential risk factors, including lipid fractions, and the occurrence of nonfatal recurrent myocardial infarction in 2402 consecutive patients who underwent primary percutaneous coronary intervention for ST segment elevation myocardial infarction.
RESULTS
The cumulative incidence of recurrent myocardial infarction was 2.7% at 1 year, 3.8% at 2 years, and 5.8% at 3 years after percutaneous coronary intervention. The effects of collinearity of lipids were investigated. In concerning the principal components analysis, composing factor 1 (scoring factors were 0.689 for non-HDL, 0.702 for LDL, 0.182 for HDL) which had eigenvalues of 1.86 and explained 62% of the variability among lipid cholesterols was significantly associated with recurrent MI in the final adjusted analysis of the lipid cholesterols principal components. Non-high-density lipoprotein cholesterol was the strongest independent predictor of nonfatal recurrent myocardial infarction. The adjusted hazards ratios for nonfatal recurrent myocardial infarction were 1.26 (95% confidence interval (CI): 1.05-1.51) for non-high-density lipoprotein cholesterol, 1.17 (95% CI: 0.99-1.39) for low-density lipoprotein and 1.15 (95% CI: 0.95-1.40) for HDL. After adjusting for gender and age, the odds ratio for patients in the highest non-high-density lipoprotein cholesterol quartile was 2.10 (95% CI: 1.19-3.72).
CONCLUSIONS
Non-high-density lipoprotein cholesterol value is a stronger predictor of nonfatal recurrent myocardial infarction than other lipid risk factors in patients with ST segment elevation myocardial infarction. Moreover, the occurrence of reinfarction after percutaneous coronary intervention was highest for patients in the highest non-high-density lipoprotein cholesterol quartile.
TRIAL REGISTRATION
http://www.chictr.org.cn/edit.aspx?pid=13583&htm=4 , registration number: ChiCTR-EPC-16008199, date of registration:2013.01.01.
背景
脂质与动脉粥样硬化、凝血及纤维蛋白溶解途径相关，可能是复发性心肌梗死的重要预后指标。本研究旨在确定中国ST段抬高型心肌梗死患者在接受初次经皮冠状动脉介入治疗2年后，基线血脂指标对非致死性复发性心肌梗死的预测价值。
方法
采用Cox比例风险模型评估包括血脂指标在内的潜在危险因素与2402例连续接受ST段抬高型心肌梗死初次经皮冠状动脉介入治疗患者发生非致死性复发性心肌梗死之间的关联。
结果
经皮冠状动脉介入治疗后1年、2年和3年复发性心肌梗死的累积发生率分别为2.7%、3.8%和5.8%。研究了脂质共线性的影响。在主成分分析中，组成因子1（非高密度脂蛋白的评分因子为0.689，低密度脂蛋白为0.702，高密度脂蛋白为0.182）的特征值为1.86，解释了脂质胆固醇变异性的62%，在脂质胆固醇主成分的最终调整分析中与复发性心肌梗死显著相关。非高密度脂蛋白胆固醇是非致死性复发性心肌梗死最强的独立预测因子。非致死性复发性心肌梗死的调整后风险比，非高密度脂蛋白胆固醇为1.26（95%置信区间（CI）：1.05 - 1.51），低密度脂蛋白为1.17（95%CI：0.99 - 1.39），高密度脂蛋白为1.15（95%CI：0.95 - 1.40）。在调整性别和年龄后，非高密度脂蛋白胆固醇处于最高四分位数的患者的比值比为2.10（95%CI：1.19 - 3.72）。
结论
对于ST段抬高型心肌梗死患者，非高密度脂蛋白胆固醇值比其他脂质危险因素更能预测非致死性复发性心肌梗死。此外，非高密度脂蛋白胆固醇处于最高四分位数的患者经皮冠状动脉介入治疗后再梗死的发生率最高。
试验注册
http://www.chictr.org.cn/edit.aspx?pid=13583&htm=4，注册号：ChiCTR - EPC - 16008199，注册日期：2013.01.01 。
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