Department of Cardiology, Cardiology Institute of Istanbul University, Istanbul University.
Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Coron Artery Dis. 2020 Jan;31(1):81-86. doi: 10.1097/MCA.0000000000000774.
Cardiovascular disease is one of the leading causes of death worldwide. According to the results of various studies, protein convertase subtilisin kexin type-9 (PCSK9) was determined as a novel risk factor for stable coronary artery disease. Few studies have investigated the relationship between PCSK9 levels and the severity of coronary artery disease in patients with acute coronary syndrome; thus, we herein aimed to investigate this relationship in patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography.
Herein, 168 patients with NSTEMI were prospectively enrolled, and severity of atherosclerotic lesions was determined using SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX), Gensini and Jeopardy scores. Plasma PCSK9 levels, lipid parameters and C-reactive protein levels were measured after a 12-h fasting period. The relationship of PCSK9 levels and clinical and laboratory parameters of patients with their SYNTAX, Gensini and Jeopardy scores was investigated.
Pearson correlation analysis showed a strong positive correlation between PCSK9 and the three scores (P < 0.001, r > 0.5 for all). In ROC analysis, a mid-high SYNTAX score of at least 25 was predicted with a sensitivity of 81% and a specificity of 63% when the PCSK9 level was higher than 52.8 ng/ml (area under a curve 0.76, P < 0.001). Multivariate linear regression analysis revealed that PCSK9, low-density lipoprotein cholesterol and creatinine levels were independent predictors of a high SYNTAX score.
Taken together, high PCSK9 levels may be a risk factor for adverse events in patients with NSTEMI. Aggressive lipid-lowering therapies may benefit this group of patients.
心血管疾病是全球范围内主要的死亡原因之一。根据各种研究的结果，蛋白转化酶枯草溶菌素 9（PCSK9）被确定为稳定型冠状动脉疾病的新型危险因素。很少有研究调查 PCSK9 水平与急性冠状动脉综合征患者冠状动脉疾病严重程度之间的关系；因此，我们旨在研究接受冠状动脉造影的非 ST 段抬高型心肌梗死（NSTEMI）患者之间的这种关系。
本前瞻性纳入了 168 例 NSTEMI 患者，使用 SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery（SYNTAX）、Gensini 和 Jeopardy 评分来确定动脉粥样硬化病变的严重程度。空腹 12 小时后测量患者的血浆 PCSK9 水平、血脂参数和 C 反应蛋白水平。研究了 PCSK9 水平与患者的临床和实验室参数及其 SYNTAX、Gensini 和 Jeopardy 评分之间的关系。
Pearson 相关分析显示，PCSK9 与三个评分之间存在强正相关（均 P<0.001，r>0.5）。在 ROC 分析中，当 PCSK9 水平高于 52.8ng/ml 时，中等至高 SYNTAX 评分≥25 的预测灵敏度为 81%，特异性为 63%（曲线下面积 0.76，P<0.001）。多变量线性回归分析显示，PCSK9、低密度脂蛋白胆固醇和肌酐水平是高 SYNTAX 评分的独立预测因子。
综上所述，高 PCSK9 水平可能是 NSTEMI 患者不良事件的危险因素。积极的降脂治疗可能使这组患者受益。
