Su Ya-Min, Zhang Rui, Xu Rong-Feng, Wang Hong-Lei, Geng Hai-Hua, Pan Min, Qu Yang-Yang, Zuo Wen-Jie, Ji Zhen-Jun, Ma Gen-Shan
Department of Cardiology, School of Medicine, Southeast University, Nanjing 210009, China.
Department of Cardiology, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471003, China.
J Thorac Dis. 2019 Dec;11(12):5087-5095. doi: 10.21037/jtd.2019.12.26.
It is clinically important to identify high-risk patients with acute coronary syndrome (ACS) who may require repeat revascularization. This retrospective study identified risk factors for repeat revascularization among ACS patients after first-time successful percutaneous coronary interventions (PCIs). The predictive value of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio for repeat revascularization was also evaluated.
We enrolled consecutive ACS patients who had coronary angiography performed during the period from 6 to 12 months after a first-time successful PCI. The primary outcome of the study was to identify the risk factors of repeat revascularization. The subjects were stratified based on repeat PCI events. After comparing various clinical characteristics, univariate and multivariate Cox proportional hazard model analyses were adopted to evaluate the effects of risk factors on repeat revascularization.
The patients (n=271) were divided into the event (+) group (n=101) and the event (-) group (n=170). In the event (+) group, target lesion revascularization (TLR) accounted for 20.79% and target vessel revascularization (TVR) accounted for 50.49% of the patients. In contrast, 52.47% of the patients required vessel revascularization (DVR). After adjustment for confounding factors, the TG/HDL-C ratio [hazard ratio (HR) =1.206, 95% confidence interval (CI): 1.016-1.431, P=0.032 for each higher TG/HDL-C ratio unit] and the Gensini score (HR =1.012, 95% CI: 1.005-1.018, P<0.001 for each higher Gensini score unit) were independent risk factors for a repeat PCI. Subgroup analyses showed that higher TG/HDL-C ratios were associated with a significantly higher risk of repeat PCIs in the male, hypertensive, and diabetes mellitus subgroups.
The TG/HDL-C ratio and Gensini score could serve as risk factors for repeat revascularization in ACS patients after a first-time successful PCI.
识别可能需要再次血运重建的急性冠状动脉综合征（ACS）高危患者具有重要的临床意义。这项回顾性研究确定了首次成功进行经皮冠状动脉介入治疗（PCI）后ACS患者再次血运重建的危险因素。还评估了甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值对再次血运重建的预测价值。
我们纳入了在首次成功PCI后6至12个月期间进行冠状动脉造影的连续ACS患者。该研究的主要结局是确定再次血运重建的危险因素。根据再次PCI事件对受试者进行分层。在比较各种临床特征后，采用单因素和多因素Cox比例风险模型分析来评估危险因素对再次血运重建的影响。
患者（n = 271）分为事件（+）组（n = 101）和事件（-）组（n = 170）。在事件（+）组中，靶病变血运重建（TLR）占患者的20.79%，靶血管血运重建（TVR）占患者的50.49%。相比之下，52.47%的患者需要进行非靶血管血运重建（DVR）。在调整混杂因素后，TG/HDL-C比值[风险比（HR）= 1.206，95%置信区间（CI）：1.016 - 1.431，每增加一个TG/HDL-C比值单位P = 0.032]和Gensini评分（HR = 1.012，95%CI：1.005 - 1.018，每增加一个Gensini评分单位P < 0.001）是再次PCI的独立危险因素。亚组分析表明，在男性、高血压和糖尿病亚组中，较高的TG/HDL-C比值与再次PCI的风险显著升高相关。
TG/HDL-C比值和Gensini评分可作为首次成功PCI后ACS患者再次血运重建的危险因素。
