Department of Cardiovascular Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, 277 West Yanta Rd., Xi'an, 710061, Shaanxi, People's Republic of China.
Department of Clinical Laboratory, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
Cardiovasc Diabetol. 2019 Apr 23;18(1):52. doi: 10.1186/s12933-019-0858-5.
Despite revascularisation, a large proportion of acute coronary syndrome (ACS) patients continue to experience major adverse cardiovascular events (MACEs), which are worsened by diabetes mellitus (DM). Fibrinogen (FIB) is a risk factor for MACEs in coronary artery disease and often elevated in DM. However, the relationships between FIB, glucose metabolism (haemoglobin A1c [HbA1c] and fasting blood glucose [FBG]) and MACEs following percutaneous coronary intervention (PCI) in DM, non-DM or whole patients with ACS remains unknown.
A total of 411 ACS patients undergoing PCI were enrolled in this study. We compared baseline FIB levels between DM (n = 103) and non-DM (n = 308) patients and divided participants into three groups according to FIB level, i.e. FIB-L, FIB-M and FIB-H, to compare baseline characteristics and MACEs. Linear regression analysis of the relationship between glucose metabolism and FIB, Cox regression, survival and landmark analyses of MACEs were also performed over a median of 27.55 months of follow-up.
Patients with DM had higher FIB levels than non-DM patients (3.56 ± 0.99 mg/dL vs. 3.34 ± 0.80 mg/dL, P < 0.05). HbA1c and FBG were significantly positively correlated with FIB in whole and DM patients but not in non-DM patients (all P < 0.05). Compared with the FIB-L group, the FIB-M (hazard ratio [HR] 1.797, 95% CI 1.117-2.892, P = 0.016) and FIB-H (HR 1.664, 95% CI 1.002-2.763, P = 0.049) groups were associated with higher MACEs in whole; the FIB-M (HR 7.783, 95% CI 1.012-59.854, P = 0.049) was associated with higher MACEs in DM patients. FIB was not associated with MACEs in non-DM patients. During landmark analysis, FIB showed better predictive value for MACEs after PCI in the first 30 months of follow up than in the subsequent period.
In this study from China, FIB was positively associated with glucose metabolism (HbA1c and FBG) in whole and DM populations with ACS. Moreover, elevated baseline FIB levels may be an important and independent predictor of MACEs following PCI, especially amongst those with DM. However, as the follow-up period increased, the baseline FIB levels lost their ability to predict MACEs.
尽管进行了血运重建，但仍有很大一部分急性冠状动脉综合征（ACS）患者会发生主要不良心血管事件（MACE），而糖尿病（DM）会使这种情况恶化。纤维蛋白原（FIB）是冠心病患者发生 MACE 的一个危险因素，并且在 DM 患者中常常升高。然而，在 DM、非 DM 或 ACS 患者中，PCI 术后 FIB、血糖代谢（糖化血红蛋白 [HbA1c] 和空腹血糖 [FBG]）与 MACE 之间的关系尚不清楚。
本研究共纳入 411 例接受 PCI 的 ACS 患者。我们比较了 DM（n=103）和非 DM（n=308）患者的基线 FIB 水平，并根据 FIB 水平将患者分为三组，即 FIB-L、FIB-M 和 FIB-H，以比较基线特征和 MACE。还对随访中位数为 27.55 个月期间 FIB 与血糖代谢之间的关系进行了线性回归分析、Cox 回归、MACE 的生存和标志分析。
DM 患者的 FIB 水平高于非 DM 患者（3.56±0.99mg/dL vs. 3.34±0.80mg/dL，P<0.05）。HbA1c 和 FBG 与全组和 DM 患者的 FIB 呈显著正相关，但与非 DM 患者无相关性（均 P<0.05）。与 FIB-L 组相比，FIB-M（危险比 [HR]1.797，95%置信区间 [CI]1.117-2.892，P=0.016）和 FIB-H（HR1.664，95%CI1.002-2.763，P=0.049）组在全组患者中与更高的 MACE 相关；FIB-M（HR7.783，95%CI1.012-59.854，P=0.049）与 DM 患者更高的 MACE 相关。FIB 与非 DM 患者的 MACE 无关。在标志分析中，FIB 在 PCI 后前 30 个月的随访中对 MACE 的预测价值优于随后的随访。
本研究来自中国，结果显示 FIB 与 ACS 全人群和 DM 人群的血糖代谢（HbA1c 和 FBG）呈正相关。此外，基线 FIB 水平升高可能是 PCI 后 MACE 的一个重要且独立的预测因素，尤其是在 DM 患者中。然而，随着随访时间的延长，基线 FIB 水平丧失了预测 MACE 的能力。
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