Liu Weizhuo, Xiong Nanqing, Xie Kun, Wu Bangwei, Qi Zhiyong, Zhou Peng, Gao Wen, Bao Liwen, Gao Xiufang, Qiu Zhaohui, Gong Hui, He Guibin, Cao Bin, Shi Haiming, Luo Xinping, Li Jian
Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China.
Department of Cardiology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
J Thromb Thrombolysis. 2020 Nov;50(4):849-857. doi: 10.1007/s11239-020-02110-x.
Patients with atrial fibrillation (AF) are associated with increased thrombotic events. Our previous case-control study showed low-density lipoprotein cholesterol (LDL-C) was an independent predictor of ischemic stroke in AF patients. To investigate the risks of thrombosis in relation to LDL-C among AF patients at different stroke risks by long-time follow-up. Atrial fibrillation patients without history of thrombosis enrolled from five hospitals were classified into low-risk (LR) and high-risk (HR) group according to CHADSVASc score and followed up with a median period of 26 months. Univariate and multivariate logistic regression analysis were performed in each group. The best cut-off value calculated by receiver operating characteristic (ROC) analysis was used to divide patients into low LDL-C (L-LDL) and high LDL-C (H-LDL) subgroups. Propensity score matching (PSM) and inverse probability of treatment weighted (IPTW) were utilized in both subgroups, after which Kaplan-Meier curves for thrombosis were performed. Univariate and multivariate analysis showed LDL-C was significantly related to thrombosis in LR, but less significantly in HR group. The best cut-off value was 2.155 mmol/L in LR and 2.795 mmol/L in HR group. Lower LDL-C was associated with decreased thrombosis in both groups by PSM and IPTW. Kaplan-Meier curves displayed that H-LDL subgroup was at higher thrombosis risk with significant difference at 24th month in LR patients. LDL-C independently predicts thrombosis with different cut-off values in AF patients at different risks. A stricter control of LDL-C level is necessary for thrombosis reduction in patients with lower score.
心房颤动（AF）患者发生血栓事件的风险增加。我们之前的病例对照研究表明，低密度脂蛋白胆固醇（LDL-C）是AF患者缺血性卒中的独立预测因素。通过长期随访，调查不同卒中风险的AF患者中与LDL-C相关的血栓形成风险。从五家医院招募的无血栓形成病史的心房颤动患者根据CHADSVASc评分分为低风险（LR）和高风险（HR）组，并进行了中位时间为26个月的随访。在每组中进行单因素和多因素逻辑回归分析。通过受试者工作特征（ROC）分析计算出的最佳截断值用于将患者分为低LDL-C（L-LDL）和高LDL-C（H-LDL）亚组。在两个亚组中均采用倾向评分匹配（PSM）和逆概率加权法（IPTW），之后绘制血栓形成的Kaplan-Meier曲线。单因素和多因素分析显示，LDL-C与LR组的血栓形成显著相关，但在HR组中相关性较弱。LR组的最佳截断值为2.155 mmol/L，HR组为2.795 mmol/L。通过PSM和IPTW分析，较低的LDL-C与两组血栓形成的减少相关。Kaplan-Meier曲线显示，H-LDL亚组的血栓形成风险较高，在LR患者的第24个月时有显著差异。LDL-C在不同风险的AF患者中以不同的截断值独立预测血栓形成。对于评分较低的患者，更严格地控制LDL-C水平对于降低血栓形成是必要的。
