Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine.
Yoshimura Clinic, Hikari.
Int Heart J. 2021;62(5):970-979. doi: 10.1536/ihj.21-015.
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.
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。