Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Peking University Third Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2021 Feb 3;11:603922. doi: 10.3389/fendo.2020.603922. eCollection 2020.
High lipoprotein(a) (Lp[a]) levels are associated with increased risks of cardiovascular events in Percutaneous Coronary Intervention (PCI) patients with diabetes mellitus (DM). Peri-procedural myocardial infarction (PMI) occurs commonly during the PCI, whereas the relationship between Lp(a) and PMI remains unclear. Our study aimed to evaluate the association between Lp(a) value and the incidence of PMI in a larger-scale diabetic cohort undergoing PCI throughout 2013.
A total of 2,190 consecutive patients with DM were divided into two groups according to the median Lp(a) level of 175 mg/L: Low Lp(a) group (N = 1095) and high Lp(a) group (N = 1095). PMI was defined based on the 2018 universal definition of myocardial infarction.
Patients with high Lp(a) levels exhibited higher rates of PMI compared to those with low Lp(a) levels (2.3% versus 0.8%, P = 0.006). The multivariable logistic analysis showed that PMI was independently predicted by Lp(a) as a dichotomous variable (OR 2.64, 95%CI 1.22-5.70) and as a continuous variable (OR 1.57, 95% CI 1.12-2.20). However, further investigation found that this association was only maintained in men, whose Lp(a) levels were significantly associated with the frequency of PMI, both as a dichotomous variable (OR 3.66, 95%CI 1.34-10.01) and as a continuous variable (OR 1.81, 95%CI 1.18-2.78). Lp(a) wasn't a risk factor of PMI in women.
High Lp(a) levels had forceful correlations with the increased frequency of PMI in male diabetic patients undergoing PCI. Lp(a) might act as a marker of risk stratification and a therapeutic target to reduce PCI-related ischemic events.
在接受经皮冠状动脉介入治疗（PCI）的糖尿病（DM）患者中，高脂蛋白（a）（Lp[a]）水平与心血管事件风险增加相关。在 PCI 过程中常发生围手术期心肌梗死（PMI），但 Lp[a]与 PMI 之间的关系尚不清楚。我们的研究旨在评估在更大规模的接受 PCI 的糖尿病队列中，Lp[a]值与 PMI 发生率之间的关系。
根据 175mg/L 的中位数，将 2190 例连续的 DM 患者分为两组：低 Lp(a)组（N=1095）和高 Lp(a)组（N=1095）。PMI 根据 2018 年心肌梗死的通用定义定义。
与低 Lp(a)组相比，高 Lp(a)组患者的 PMI 发生率更高（2.3%比 0.8%，P=0.006）。多变量逻辑分析显示，PMI 独立地由 Lp(a)作为二分类变量（OR 2.64，95%CI 1.22-5.70）和连续变量（OR 1.57，95%CI 1.12-2.20）预测。然而，进一步的研究发现，这种相关性仅在男性中维持，其 Lp(a)水平与 PMI 的频率显著相关，无论是作为二分类变量（OR 3.66，95%CI 1.34-10.01）还是作为连续变量（OR 1.81，95%CI 1.18-2.78）。Lp(a)不是女性 PMI 的危险因素。
高 Lp(a)水平与接受 PCI 的男性糖尿病患者 PMI 频率增加有强烈的相关性。Lp(a)可能是一种风险分层的标志物和减少 PCI 相关缺血事件的治疗靶点。
