Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire, PEC2, EA 7460, University of Bourgogne Franche-Comté, Dijon, France.
INSERM UMR 1188 Détroi, Université de la Réunion, Sainte Clotilde, France.
Nutr Metab Cardiovasc Dis. 2021 Mar 10;31(3):880-885. doi: 10.1016/j.numecd.2020.11.010. Epub 2020 Nov 20.
It remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future events in patients with coronary artery disease (CAD). We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography (SYNTAX score), and the risk of in-hospital events and at one-year follow-up.
From September 2015 to December 2016, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy, and admitted for an acute myocardial infarction (MI), in an intensive care unit from a university hospital. In a total of 648 patients (mean age: 66 years, 67% male), median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs 256 ng/ml, p = 0.009). Serum PCSK9 was associated with LDL cholesterol (r = 0.083, p = 0.036), total cholesterol (r = 0.136, p = 0.001) and triglycerides (r = 0.137, p = 0.001). A positive association was also observed in the subgroup of patients with CRP >10 mg/L (p < 0.001), but not with NT-proBNP, troponin and creatine kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. PCSK9 levels were not associated with in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up.
In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels was not associated with the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels for this category of patients therefore appears limited.
目前尚不清楚血清 PCSK9 水平是否可以预测冠心病（CAD）患者疾病的严重程度和未来事件的风险。我们旨在评估 PCSK9 水平、代谢参数、冠状动脉造影（SYNTAX 评分）上 CAD 的严重程度以及住院期间和一年随访时事件的风险之间的关联。
2015 年 9 月至 2016 年 12 月，在一家大学医院的重症监护病房中，对未接受他汀类药物治疗的急性心肌梗死（MI）患者入院时测量血清 PCSK9 水平。在总共 648 名患者（平均年龄 66 岁，67%为男性）中，中位数 PCSK9 为 263ng/ml，女性高于男性（270 与 256ng/ml，p=0.009）。血清 PCSK9 与 LDL 胆固醇（r=0.083，p=0.036）、总胆固醇（r=0.136，p=0.001）和甘油三酯（r=0.137，p=0.001）相关。在 CRP>10mg/L 的患者亚组中也观察到正相关（p<0.001），但与 NT-proBNP、肌钙蛋白和肌酸激酶无关。无论 SYNTAX 评分或有意义的冠状动脉病变数量如何，PCSK9 水平都相似。PCSK9 水平与住院期间的事件（死亡、复发性 MI 和中风）和一年随访时的事件（心血管死亡、心血管事件、复发性 MI）无关。
在因急性 MI 住院且未接受他汀类药物治疗的大量患者中，PCSK9 水平与心血管事件的严重程度或复发无关。因此，对于这一类患者，测量 PCSK9 水平的临床效用似乎有限。
