Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
Department of Outpatient, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
BMC Cardiovasc Disord. 2021 Apr 12;21(1):169. doi: 10.1186/s12872-021-01979-7.
Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI.
Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE.
A total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37-2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status.
Patients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.
尽管进行了有效的低密度脂蛋白胆固醇（LDL-C）降低治疗，但仍存在显著的残余风险。小而密的低密度脂蛋白胆固醇（sdLDL-C）作为 LDL-C 的一部分，已被发现是稳定型冠心病（CHD）患者发生冠心病（CHD）和心血管（CV）事件的独立预测因子。然而，迄今为止，很少有研究探讨 sdLDL-C 在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中的作用。因此，本研究旨在评估 sdLDL-C 与接受 PCI 的 ACS 患者 CV 事件的相关性。
入选因 ACS 住院并接受 PCI 的患者，并进行 18 个月的随访。根据 sdLDL-C 四分位值比较 sdLDL-C 对 CV 事件的风险。主要终点为主要心血管和脑血管不良事件（MACCE），即全因死亡、非致死性心肌梗死（MI）、非致死性卒中和计划外再次血运重建的复合终点。采用 Cox 比例风险回归模型评估 CV 事件的风险。根据糖尿病状态和 LDL-C 对 MACCE 进行亚组分析。
共纳入 6092 例患者（年龄：60.2±10.13 岁，男性：75.3%，BMI：25.9±3.33 kg/m，血脂异常：74.1%，糖尿病：44.5%）。在 18 个月的随访期间，发生 320 例（5.2%）CV 事件。与最低 sdLDL-C 四分位组相比，多变量调整后，最高四分位组患者发生 CV 事件的风险更高（HR 1.92；95%CI 1.37-2.70）。此外，这主要归因于计划外再次血运重建的增加。在亚组分析中，无论 LDL-C 水平和糖尿病状态如何，均观察到显著相关性。
在中国接受 PCI 的 ACS 患者中，sdLDL-C 升高的患者发生 CV 事件的风险更高，为更好地评估风险提供了额外的价值。
