Hu Chengping, Liu Jinxing, Han Hongya, Sun Yan, Cheng Yujing, Liu Yan, Gao Ang, Zhou Yujie, Zhang Jianwei, Zhao Yingxin
Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Feb 19;8:637366. doi: 10.3389/fcvm.2021.637366. eCollection 2021.
Lipoprotein(a) [Lp(a)] has been thought as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). The Global Registry of Acute Coronary Events (GRACE) score is used to predict the risk of death or death/non-fatal myocardial infarction in patients with acute coronary syndromes (ACS). It suggests that there may be a synergism between Lp(a) and the GRACE risk score on predicting cardiovascular events. Accordingly, this study aimed to test the hypothesis that Lp(a)-related cardiovascular risk could be significantly modulated by the GRACE risk score in patients with ACS undergoing percutaneous coronary intervention (PCI). Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The primary outcome was the composite of death, non-fatal myocardial infarction, non-fatal stroke, and unplanned repeat revascularization. A Cox proportional hazard regression model was used to determine the relationship between Lp(a) and cardiovascular events. A total of 6,309 patients were included (age: 60.1 ± 10.06 years, male: 75.2%, BMI: 26.2 ± 10.57 kg/m). A total of 310 (4.9%) cardiovascular events occurred. When the overall population was stratified by a GRACE score of 91 or less vs. more than 91 and by tertiles of Lp(a), higher Lp(a) was significantly associated with cardiovascular events only when the GRACE score was <91(tertile 2 vs. tertile 1: HR 1.31, 95% CI: 0.86-1.98, = 0.205; tertile 3 vs. tertile 1: HR 1.94, 95% CI: 1.32-2.84, = 0.001; = 0.002). However, no such significant correlation between cardiovascular events and Lp(a) emerged in the case of a GRACE score 91 or less, and there was a significant interaction for cardiovascular events between Lp(a) tertiles and dichotomized GRACE scores ( < 0.001). In ACS patients undergoing PCI, there was a synergistic effect between the GRACE risk score and on-statins Lp(a) on predicting cardiovascular events. This finding could help us more accurately identify patients who would benefit most from Lp(a)-lowering treatment.
脂蛋白(a)[Lp(a)]一直被认为是动脉粥样硬化性心血管疾病(ASCVD)的独立危险因素。全球急性冠状动脉事件注册研究(GRACE)评分用于预测急性冠状动脉综合征(ACS)患者的死亡风险或死亡/非致命性心肌梗死风险。这表明Lp(a)与GRACE风险评分在预测心血管事件方面可能存在协同作用。因此，本研究旨在验证以下假设：在接受经皮冠状动脉介入治疗(PCI)的ACS患者中，GRACE风险评分可显著调节与Lp(a)相关的心血管风险。纳入因ACS住院并接受PCI治疗的患者，并随访18个月。主要结局是死亡、非致命性心肌梗死、非致命性卒中以及计划外再次血运重建的复合结局。采用Cox比例风险回归模型来确定Lp(a)与心血管事件之间的关系。共纳入6309例患者(年龄：60.1±10.06岁，男性：75.2%，体重指数：26.2±10.57kg/m)。共发生310例(4.9%)心血管事件。当总体人群按GRACE评分≤91与>91以及Lp(a)三分位数分层时，仅当GRACE评分<91时，较高的Lp(a)才与心血管事件显著相关(三分位数2与三分位数1：风险比1.31，95%置信区间：0.86 - 1.98，P = 0.205；三分位数3与三分位数1：风险比1.94，95%置信区间：1.32 - 2.84，P = 0.001；交互作用P = 0.002)。然而，在GRACE评分≥91的情况下，心血管事件与Lp(a)之间未出现这种显著相关性，并且Lp(a)三分位数与二分GRACE评分之间在心血管事件方面存在显著交互作用(P<0.001)。在接受PCI的ACS患者中，GRACE风险评分与非他汀类药物治疗的Lp(a)在预测心血管事件方面存在协同效应。这一发现有助于我们更准确地识别出最能从降低Lp(a)治疗中获益的患者。
