γ-谷氨酰转移酶/血小板比值作为经皮冠状动脉介入治疗后患者长期不良结局的新型预测因子：一项回顾性队列研究。
Gamma-Glutamyl Transferase-to-Platelet Ratio as a Novel Predictor of Long-Term Adverse Outcomes in Patients after Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study.
机构信息
Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China.
Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
出版信息
Thromb Haemost. 2019 Jun;119(6):1021-1030. doi: 10.1055/s-0039-1681103. Epub 2019 Mar 1.
BACKGROUND
Gamma-glutamyl transferase (GGT) has been shown to be involved in the pathogenesis of both coronary artery disease (CAD) and liver disease, and it has been reported that the GGT-to-platelet ratio (GPR) is an independent predictor for adverse outcomes from liver fibrosis and hepatic carcinoma. However, the relation between the GPR and adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) has not been investigated.
METHODS
A total of 5,636 patients enrolled in Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI, a retrospective cohort study, from January 2008 to December 2016, were divided into two groups according to GPR (GPR < 0.12, = 2,769 and GPR ≥ 0.12, = 2,867). The primary outcome was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM) after PCI. The average follow-up time was 35.9 ± 22.6 months.
RESULTS
We found that there were significant differences between the two groups in the incidences of ACM ( = 0.011), CM ( = 0.001), major adverse cardiovascular events (MACEs, < 0.024), major adverse cardiovascular and cerebrovascular events (MACCEs, = 0.014) and bleeding events ( = 0.003). Multivariate Cox regression analyses showed that GPR was an independent predictor for ACM (hazard ratio [HR]: 1.536 [95% confidence interval [CI]:1.162-2.032], = 0.003), CM (HR: 1.763 [95% CI: 1.283-2.424], < 0.001), MACCEs (HR: 1.269 [95% CI: 1.066-1.511], = 0.007) and MACEs (HR: 1.308 [95% CI: 1.089-1.570], = 0.004) in stable CAD patients but that it was an independent predictor for only the incidence of bleeding events (HR: 3.104 [95% CI: 1.680-5.736], < 0.001) in acute coronary syndrome (ACS) patients.
CONCLUSION
This study indicates that GPR is an independent and novel predictor of adverse long-term outcomes in CAD patients who underwent PCI.
背景
γ-谷氨酰转移酶（GGT）已被证明与冠状动脉疾病（CAD）和肝脏疾病的发病机制有关，并且已经报道 GGT 与血小板比值（GPR）是肝纤维化和肝细胞癌不良预后的独立预测因子。然而，在经皮冠状动脉介入治疗（PCI）后 CAD 患者中，GPR 与不良结局之间的关系尚未得到研究。
方法
共纳入 5636 例患者，这些患者来自回顾性队列研究——2008 年 1 月至 2016 年 12 月期间进行的经皮冠状动脉介入治疗后冠心病患者的临床结局和危险因素研究（Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI），根据 GPR（GPR<0.12，=2769 例；GPR≥0.12，=2867 例）将患者分为两组。主要结局是 PCI 后长期死亡率，包括全因死亡率（ACM）和心脏死亡率（CM）。平均随访时间为 35.9±22.6 个月。
结果
我们发现两组在 ACM（=0.011）、CM（=0.001）、主要不良心血管事件（MACEs，<0.024）、主要不良心血管和脑血管事件（MACCEs，=0.014）和出血事件（=0.003）的发生率方面存在显著差异。多变量 Cox 回归分析表明，GPR 是 ACM（危险比 [HR]：1.536 [95%置信区间 [CI]：1.162-2.032]，=0.003）、CM（HR：1.763 [95% CI：1.283-2.424]，<0.001）、MACCEs（HR：1.269 [95% CI：1.066-1.511]，=0.007）和 MACEs（HR：1.308 [95% CI：1.089-1.570]，=0.004）的独立预测因子，但它仅是急性冠脉综合征（ACS）患者出血事件（HR：3.104 [95% CI：1.680-5.736]，<0.001）的独立预测因子。
结论
本研究表明，GPR 是 PCI 治疗后 CAD 患者不良长期结局的独立和新的预测因子。
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