Gao Ang, Liu Jinxing, Liu Yan, Hu Chengping, Zhu Yong, Zhou Yujie, Han Hongya, Zhao Yingxin
Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China.
Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Diabetol Metab Syndr. 2022 Apr 21;14(1):57. doi: 10.1186/s13098-022-00829-6.
This study intends to explore whether, or to what extent, the estimated remnant-like particle cholesterol was associated with coronary collateralization in patients with chronic total occlusion lesions.
792 patients with at least one coronary chronic total occlusion lesion were enrolled. Serum level of lipid profiles were determined and the estimated remnant-like particle cholesterol was calculated. The development of coronary collateralization was graded as low (Rentrop score 0-1) or high (Rentrop score 2-3) collateralization according to the Rentrop classification system and then the association between the estimated remnant-like particle cholesterol and collateralization was assessed.
222 participants were classified into low collateralization group. The estimated remnant-like particle cholesterol level was significantly higher in low collateralization (P < 0.001) and type 2 diabetes mellitus (P = 0.009) group. To further explore the association between the estimated remnant-like particle cholesterol and the development of coronary collateralization, these patients were divided into 3 groups based on the estimated remnant-like particle cholesterol tertiles. The prevalence of low collateralization increased stepwise with the tertile groups (T1 12.5% vs. 27.1% vs. 45.3%, P < 0.001). Multivariate logistic regression analysis showed that the estimated remnant-like particle cholesterol was independently associated with the under-developed collateralization, with an OR and 95%CI of 2.34 (1.46-3.74) and 4.91 (3.01-8.02) in the T2 and T3 group, respectively. The following receiver-operating characteristic analysis indicated that the diagnostic value of estimated remnant-like particle cholesterol for the low collateralization was 0.696, with a cut-off value of 0.485, and its sensitivity was 82.88%. Besides, the addition of the estimated remnant-like particle cholesterol into the baseline model consisting of traditional risk factors could improve the incremental value of the discrimination of impaired collateralization only in overall and type 2 diabetes mellitus populations.
The increased estimated remnant-like particle cholesterol is independently associated with impaired collateralization in patients with coronary chronic total occlusion lesions. Therapies targeting at remnant-like particle cholesterol may be needed in advanced coronary artery disease patients with type 2 diabetes mellitus not suitable for vascular revascularization.
本研究旨在探讨估计的残余样颗粒胆固醇是否或在何种程度上与慢性完全闭塞病变患者的冠状动脉侧支循环形成相关。
纳入792例至少有一处冠状动脉慢性完全闭塞病变的患者。测定血脂谱的血清水平并计算估计的残余样颗粒胆固醇。根据Rentrop分类系统，将冠状动脉侧支循环的发展分为低（Rentrop评分0 - 1）或高（Rentrop评分2 - 3）侧支循环，然后评估估计的残余样颗粒胆固醇与侧支循环之间的关联。
222名参与者被分类为低侧支循环组。低侧支循环组（P < 0.001）和2型糖尿病组（P = 0.009）的估计残余样颗粒胆固醇水平显著更高。为了进一步探讨估计的残余样颗粒胆固醇与冠状动脉侧支循环发展之间的关联，根据估计的残余样颗粒胆固醇三分位数将这些患者分为3组。低侧支循环的患病率随三分位数组逐步增加（T1为12.5%对27.1%对45.3%，P < 0.001）。多因素逻辑回归分析表明，估计的残余样颗粒胆固醇与侧支循环发育不良独立相关，T2和T3组的OR及95%CI分别为2.34（1.46 - 3.74）和4.91（3.01 - 8.02）。随后的受试者工作特征分析表明，估计的残余样颗粒胆固醇对低侧支循环的诊断价值为0.696，截断值为0.485，其敏感性为82.88%。此外，将估计的残余样颗粒胆固醇添加到由传统危险因素组成的基线模型中，仅在总体人群和2型糖尿病人群中可提高对侧支循环受损的鉴别增量价值。
估计的残余样颗粒胆固醇升高与冠状动脉慢性完全闭塞病变患者的侧支循环受损独立相关。对于不适合血管重建的2型糖尿病晚期冠状动脉疾病患者，可能需要针对残余样颗粒胆固醇的治疗。
