脂蛋白(a)浓度对经皮冠状动脉介入治疗患者长期心血管结局的影响：一项大型队列研究。
Impact of Lipoprotein(a) concentrations on long-term cardiovascular outcomes in patients undergoing percutaneous coronary intervention: A large cohort study.
机构信息
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
出版信息
Nutr Metab Cardiovasc Dis. 2022 Jul;32(7):1670-1680. doi: 10.1016/j.numecd.2022.03.024. Epub 2022 Apr 2.
BACKGROUND AND AIMS
Till now, the prognostic value of lipoprotein(a) [Lp(a)] in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) remains controversial. We therefore conducted this study to evaluate the effect of Lp(a) levels on clinical outcomes in this population.
METHODS AND RESULTS
A total of 10,059 CAD patients who underwent PCI were prospectively enrolled in this cohort study, of which 6564 patients had Lp(a) ≤30 mg/dl and 3495 patients had Lp(a) > 30 mg/dl. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, stroke or unplanned revascularization. Multivariate Cox regression analysis and propensity-score matching analysis were performed. After propensity-score matching, 3449 pairs of patients were identified, and post-matching absolute standardized differences were <10% for all the covariates. At 2.4 years, the risk of MACCE was significantly higher in patients with elevated Lp(a) levels than those with normal Lp(a) levels in both overall population (13.0% vs. 11.4%; adjusted hazard ratio [HR] 1.142, 95% confidence interval [CI] 1.009-1.293; P = 0.040) and propensity-matched cohorts (13.0% vs. 11.2%; HR 1.167, 95%CI 1.019-1.337; P = 0.026). Of note, the predictive value of Lp(a) levels on MACCE tended to be more evident in individuals >65 years or those with left main and/or three-vessel disease. On the contrary, elevated Lp(a) levels had almost no effect on clinical outcomes in patients ≤65 years (P = 0.021) as well as those who had one- or two-vessel coronary artery disease (P = 0.086).
CONCLUSION
In CAD patients who underwent PCI, elevated Lp(a) levels were positively related to higher risk of MACCE at 2.4-year follow-up, especially in patients >65 years and those with left main and/or three-vessel disease.
REGISTRATION NUMBER
not applicable.
背景与目的
脂蛋白(a) [Lp(a)] 在接受经皮冠状动脉介入治疗 (PCI) 的冠状动脉疾病 (CAD) 患者中的预后价值仍存在争议。因此，我们进行了这项研究，以评估该人群中 Lp(a) 水平对临床结局的影响。
方法和结果
这项前瞻性队列研究共纳入 10059 例接受 PCI 的 CAD 患者，其中 6564 例患者的 Lp(a) ≤30 mg/dl，3495 例患者的 Lp(a) > 30 mg/dl。主要终点是主要不良心脑血管事件 (MACCE)，定义为全因死亡、心肌梗死、卒中和计划外血运重建的复合终点。进行了多变量 Cox 回归分析和倾向评分匹配分析。在倾向评分匹配后，确定了 3449 对患者，所有协变量的匹配后绝对标准化差异均<10%。在 2.4 年时，在整个人群和倾向评分匹配队列中，Lp(a) 水平升高的患者的 MACCE 风险明显高于 Lp(a) 水平正常的患者[13.0%比 11.4%；调整后的风险比（HR）1.142，95%置信区间（CI）1.009-1.293；P=0.040]和倾向评分匹配队列[13.0%比 11.2%；HR 1.167，95%CI 1.019-1.337；P=0.026]。值得注意的是，Lp(a) 水平对 MACCE 的预测价值在年龄>65 岁或存在左主干和/或三血管疾病的患者中似乎更为明显。相反，在年龄≤65 岁的患者（P=0.021）和存在单支或两支冠状动脉疾病的患者（P=0.086）中，升高的 Lp(a) 水平对临床结局几乎没有影响。
结论
在接受 PCI 的 CAD 患者中，Lp(a) 水平升高与 2.4 年随访时 MACCE 风险升高呈正相关，尤其是在年龄>65 岁和存在左主干和/或三血管疾病的患者中。
注册号
不适用。
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