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非空腹性高甘油三酯血症是冠心病患者初次行单纯金属支架植入术后冠状动脉支架内再狭窄的独立危险因素。

Non-Fasting Hypertriglyceridemia as an Independent Risk Factor for Coronary In-Stent Restenosis after Primary Bare Metal Stent Implantation in Patients with Coronary Artery Disease.

机构信息

Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine.

Yoshimura Clinic, Hikari.

出版信息

Int Heart J. 2021;62(5):970-979. doi: 10.1536/ihj.21-015.

Abstract

After a percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), in-stent neoatherosclerosis may pose a risk of in-stent restenosis (ISR). To clarify whether non-fasting hypertriglyceridemia contributes to ISR, we examined the relationship between non-fasting hypertriglyceridemia (i.e., triglyceride (TG) level ≥ 200 mg/dL) and ISR after stenting with a bare metal stent (BMS) post-primary PCI in patients with CAD by means of a single-site retrospective analysis. A total of 1,039 patients with CAD were enrolled, and 86 patients (112 lesions) were evaluated for BMS-ISR 3-6 months post-primary PCI. The percentage of patients with non-fasting hypertriglyceridemia was significantly higher in the ISR (+) group than in the ISR (-) group (P < 0.009). The follow-up period and number of patients in the ISR (+) group were significantly smaller than those in the ISR (-) group (P < 0.001). There were no significant between-group differences in the other baseline patient characteristics before the primary PCI or at the time of the follow-up coronary angiography. However, at the follow-up period, the ISR (+) group had significantly lower diastolic blood pressure and high-density lipoprotein cholesterol levels (P = 0.015) and significantly higher TG levels (P = 0.012) than the ISR (-) group. A multiple logistic regression analysis demonstrated that non-fasting hypertriglyceridemia and a follow-up period of ≥ 6 months were independent risk factors for ISR after primary PCI in patients with BMS implantation for stenotic CAD (P = 0.006), with an adjusted odds ratio of 8.232 (1.201-56.410) and 0.006 (95% confidence interval < 0.001-0.045), respectively. Non-fasting hypertriglyceridemia may be an additional independent risk factor for BMS-ISR after primary PCI in patients with CAD.

摘要

经皮冠状动脉介入治疗(PCI)后,冠状动脉疾病(CAD)患者的支架内新出现动脉粥样硬化可能会增加支架内再狭窄(ISR)的风险。为了明确非空腹高甘油三酯血症是否会导致 ISR,我们通过单中心回顾性分析,研究了 CAD 患者经皮冠状动脉介入治疗后植入裸金属支架(BMS)后,非空腹高甘油三酯血症(即甘油三酯(TG)水平≥200mg/dL)与 ISR 的关系。共纳入 1039 例 CAD 患者,其中 86 例(112 处病变)在经皮冠状动脉介入治疗后 3-6 个月接受了 BMS-ISR 评估。在 ISR(+)组中,非空腹高甘油三酯血症患者的比例明显高于 ISR(-)组(P<0.009)。ISR(+)组的随访时间和患者数量明显少于 ISR(-)组(P<0.001)。在原发性 PCI 前或随访冠状动脉造影时,两组患者的其他基线特征无显著差异。然而,在随访期间,ISR(+)组的舒张压和高密度脂蛋白胆固醇水平明显低于 ISR(-)组(P=0.015),TG 水平明显高于 ISR(-)组(P=0.012)。多因素 logistic 回归分析表明,非空腹高甘油三酯血症和随访时间≥6 个月是 CAD 患者 BMS 植入后原发性 PCI 后发生 ISR 的独立危险因素(P=0.006),调整后的比值比分别为 8.232(1.201-56.410)和 0.006(95%置信区间<0.001-0.045)。非空腹高甘油三酯血症可能是 CAD 患者 BMS-ISR 后原发性 PCI 的另一个独立危险因素。

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