Zeng Rui-Xiang, Li Sha, Zhang Min-Zhou, Li Xiao-Lin, Zhu Cheng-Gang, Guo Yuan-Lin, Zhang Yan, Li Jian-Jun
Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiol. 2017 Aug;70(2):113-120. doi: 10.1016/j.jjcc.2016.12.010. Epub 2017 Feb 13.
Remnant cholesterol (RC) is receiving increasing attention regarding its relation to cardiovascular risk. Whether RC is associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in type 2 diabetes (T2D) is currently unknown.
We prospectively enrolled 1182 consecutive T2D patients who were scheduled for PCI but with baseline normal preprocedural cardiac troponin I (cTnI). Patients were divided according to their glycemic control status: group A [glycated hemoglobin (HbA1c)<7%, n=563] and group B (HbA1c≥7%, n=619). PMI was evaluated by cTnI analysis within 24h. The associations of preprocedural RC and the RC to high-density lipoprotein cholesterol ratio (RC/HDL-C) with PMI were investigated.
The associations of RC and RC/HDL-C with PMI were observed in group B (both p<0.05) but not in group A (both p>0.05). Patients in group B, a 1-SD increase of RC produced 30% and 32% increased risk for postprocedural cTnI>3× upper limit of normal (ULN) and >5×ULN, respectively. The odds ratios for RC/HDL-C were the highest compared with any cholesterol fractions including total cholesterol (TC)/HDL-C, low density lipoprotein cholesterol (LDL-C)/HDL-C, nonHDL-C/HDL-C, and triglyceride/HDL-C with 1.43 [95% confidence interval (CI): 1.10-1.88] for >3× ULN and 1.49 (95% CI: 1.13-1.97) for >5× ULN. However, no such associations were found in group A. Furthermore, patients with RC >27.46mg/dL (third tertile) [RC≤14.15mg/dL (first tertile) as reference] were associated with a 1.57-fold and 2-fold increased risk for >3× ULN and >5× ULN in group B, respectively.
RC and RC/HDL-C might be valuable, independent predictors for PMI in poorly-controlled diabetic patients undergoing PCI.
残余胆固醇（RC）与心血管风险的关系日益受到关注。目前尚不清楚RC是否与2型糖尿病（T2D）患者经皮冠状动脉介入治疗（PCI）后的围手术期心肌损伤（PMI）相关。
我们前瞻性纳入了1182例计划接受PCI但术前心肌肌钙蛋白I（cTnI）基线正常的连续T2D患者。根据血糖控制状况将患者分为两组：A组[糖化血红蛋白（HbA1c）<7%，n = 563]和B组（HbA1c≥7%，n = 619）。在24小时内通过cTnI分析评估PMI。研究术前RC以及RC与高密度脂蛋白胆固醇比值（RC/HDL-C）与PMI的关联。
在B组中观察到RC和RC/HDL-C与PMI有关联（两者p<0.05），而在A组中未观察到（两者p>0.05）。在B组患者中，RC每增加1个标准差，术后cTnI>3倍正常上限（ULN）和>5倍ULN的风险分别增加30%和32%。与包括总胆固醇（TC）/HDL-C、低密度脂蛋白胆固醇（LDL-C）/HDL-C、非HDL-C/HDL-C和甘油三酯/HDL-C在内的任何胆固醇组分相比，RC/HDL-C的优势比最高，对于>3倍ULN为1.43[95%置信区间（CI）：1.10 - 1.88]，对于>5倍ULN为1.49（95%CI：1.13 - 1.97）。然而，在A组中未发现此类关联。此外，在B组中，RC>27.46mg/dL（第三三分位数）[以RC≤14.15mg/dL（第一三分位数）为参照]的患者，术后cTnI>3倍ULN和>5倍ULN的风险分别增加1.57倍和2倍。
RC和RC/HDL-C可能是接受PCI的血糖控制不佳的糖尿病患者PMI的有价值的独立预测指标。
