Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Am J Cardiol. 2020 Oct 15;133:54-60. doi: 10.1016/j.amjcard.2020.07.032. Epub 2020 Jul 25.
The pharmacological inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) has been shown to drastically affect low-density lipoprotein cholesterol levels and associated cardiovascular diseases. However, the potential effectiveness of PCSK9 serum levels as a biomarker for cardiovascular risk remains unclear. Serum PCSK9 levels in patients who underwent percutaneous coronary intervention (PCI) may predict long-term outcomes. PCSK9 levels were measured in 749 consecutive patients with coronary artery disease undergoing PCI. These patients were classified into 2 groups according to their serum levels of PCSK9. The primary end point was a composite of the major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stroke, and any revascularization. The median PCSK9 level was 302.82 ng/ml. During a median follow-up of 28.4 months, a total of 38 (5.1%) MACE was recorded, and 50 (6.7%) patients died from any cause. Multivariate Cox regression analysis showed that compared with a lower serum PCSK9 level, a higher serum PCSK9 level was independently associated with a higher rate of MACE (adjusted hazard ratio 2.290, 95% confidence interval 1.040 to 5.045, p = 0.040) and all-cause death (adjusted hazard ratio 2.511, 95% confidence interval 1.220 to 5.167, p = 0.026). Results were consistent after propensity-score matching (MACE, adjusted HR 2.236, 95% CI 1.011-5.350, p = 0.047; all-cause death, adjusted HR 2.826, 95% CI 1.258-6.349, p = 0.012). Baseline serum PCSK9 levels were associated with long-term cardiovascular clinical outcomes and mortality during the long-term follow-up after PCI in patients with coronary artery disease.
蛋白水解酶枯草溶菌素 9（PCSK9）的药理学抑制作用已被证明可显著影响低密度脂蛋白胆固醇水平和相关心血管疾病。然而，PCSK9 血清水平作为心血管风险生物标志物的潜在有效性仍不清楚。接受经皮冠状动脉介入治疗（PCI）的患者的血清 PCSK9 水平可能预测长期结局。对 749 例接受 PCI 的冠心病患者进行了 PCSK9 水平测量。这些患者根据其 PCSK9 血清水平分为 2 组。主要终点是主要不良心脏事件（MACE）的复合终点，包括心脏死亡、心肌梗死、卒中和任何血运重建。PCSK9 水平的中位数为 302.82ng/ml。在中位随访 28.4 个月期间，共记录到 38 例（5.1%）MACE，50 例（6.7%）患者因任何原因死亡。多变量 Cox 回归分析显示，与较低的血清 PCSK9 水平相比，较高的血清 PCSK9 水平与较高的 MACE 发生率独立相关（调整后的危险比 2.290，95%置信区间 1.040 至 5.045，p=0.040）和全因死亡（调整后的危险比 2.511，95%置信区间 1.220 至 5.167，p=0.026）。倾向评分匹配后结果一致（MACE，调整后的 HR 2.236，95%CI 1.011-5.350，p=0.047；全因死亡，调整后的 HR 2.826，95%CI 1.258-6.349，p=0.012）。在冠心病患者 PCI 后长期随访期间，基线血清 PCSK9 水平与长期心血管临床结局和死亡率相关。
