Matsuoka Yuta, Ike Amane, Ogawa Masahiro, Gondo Kouki, Shirai Kazuyuki, Sugihara Makoto, Nose Daisuke, Nishikawa Hiroaki, Iwata Atsushi, Kawamura Akira, Mori Ken, Zhang Bo, Yasunaga Shin'ichiro, Miura Shin-Ichiro, Saku Keijiro
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
J Cardiol. 2018 Mar;71(3):259-267. doi: 10.1016/j.jjcc.2017.09.011. Epub 2017 Nov 10.
Since single lipid parameters are too weak to predict the risk of coronary artery disease, we examined whether the allocation of patients into four groups based on achievement of the target levels set by the Japan Atherosclerosis Guidelines at the time of percutaneous coronary intervention (PCI) would reveal different long-term (5 years) clinical outcomes in males and females.
The results of a 5-year follow-up study are summarized as FU-Registry, Long-Term Clinical Outcome Results. The subjects consisted of 1158 patients who underwent elective PCI. The male and female patients were separately allocated into four groups: (1) high-density lipoprotein cholesterol (HDL-C≥40mg/dl as well as low-density lipoprotein-cholesterol (LDL-C)≥100mg/dl); (2) HDL-C≥40mg/dl as well as LDL-C<100mg/dl; (3) HDL-C<40mg/dl as well as LDL-C≥100mg/dl; (4) HDL-C<40mg/dl as well as LDL-C<100mg/dl, for a comparison of both patient as well as lesion characteristics and the endpoint of major adverse cardiac events (MACEs).
Regarding lesion characteristics, significant differences (p<0.05) were detected in the usage rate of a drug-eluting stent (DES) as well as the bend, stent reference diameter, and stent minimum lumen diameter in females by ANOVA, and in severe calcification, the bend, and usage rate of DES (p<0.001) in males. In females, significant differences (p<0.05) were observed in MACEs and target lesion revascularization-PCI. In contrast, among males, the four groups had nearly equivalent outcomes. Uni- and multivariate analyses revealed that HDL-C as well as LDL-C in females were associated with MACEs [OR 3.29 (95% CI 1.05-8.57, p=0.04)], while no association was observed in male multivariate analysis.
In female patients, HDL-C<40mg/dl and LDL-C≥100mg/dl were even more strongly related to MACEs, whereas the combination of LDL-C and HDL-C was not related to MACEs in male patients.
由于单一血脂参数预测冠状动脉疾病风险的能力较弱，我们研究了根据经皮冠状动脉介入治疗（PCI）时日本动脉粥样硬化指南设定的目标水平将患者分为四组，是否会在男性和女性中显示出不同的长期（5年）临床结局。
一项5年随访研究的结果总结为FU注册研究，长期临床结局结果。研究对象包括1158例行择期PCI的患者。男性和女性患者分别被分为四组：（1）高密度脂蛋白胆固醇（HDL-C≥40mg/dl）以及低密度脂蛋白胆固醇（LDL-C≥100mg/dl）；（2）HDL-C≥40mg/dl以及LDL-C<100mg/dl；（3）HDL-C<40mg/dl以及LDL-C≥100mg/dl；（4）HDL-C<40mg/dl以及LDL-C<100mg/dl，以比较患者和病变特征以及主要不良心脏事件（MACE）的终点。
关于病变特征，通过方差分析在女性中检测到药物洗脱支架（DES）的使用率以及弯曲度、支架参考直径和支架最小管腔直径存在显著差异（p<0.05），在男性中检测到严重钙化、弯曲度和DES使用率存在显著差异（p<0.001）。在女性中，MACE和靶病变血运重建-PCI存在显著差异（p<0.05）。相比之下，在男性中，四组的结局几乎相同。单因素和多因素分析显示，女性的HDL-C以及LDL-C与MACE相关[OR 3.29（95%CI 1.05-8.57，p=0.04）]，而在男性多因素分析中未观察到相关性。
在女性患者中，HDL-C<40mg/dl和LDL-C≥100mg/dl与MACE的相关性更强，而在男性患者中，LDL-C和HDL-C的组合与MACE无关。
