直接测量的低密度脂蛋白胆固醇与计算得出的低密度脂蛋白胆固醇相比，无法识别出更多患有冠状动脉疾病和糖尿病且发生不良事件风险更高的个体：来自亚洲一项大型经皮冠状动脉介入治疗队列研究的见解

Directly Measured vs. Calculated Low-Density Lipoprotein Cholesterol Does Not Identify Additional Individuals With Coronary Artery Disease and Diabetes at Higher Risk of Adverse Events: Insight From a Large Percutaneous Coronary Intervention Cohort in Asia.

作者信息

Shi Boqun, Wang Hao-Yu, Liu Jinpeng, Cai Zhongxing, Song Chenxi, Jia Lei, Yin Dong, Wang Hongjian, Dou Ke-Fei, Song Weihua

机构信息

Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Cardiovasc Med. 2022 Jul 7;9:932878. doi: 10.3389/fcvm.2022.932878. eCollection 2022.

DOI:10.3389/fcvm.2022.932878

PMID:35872896

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9301080/

Abstract

BACKGROUND

The objective of our study was to assess whether calculated low-density lipoprotein cholesterol (LDL-C) is inferior to direct LDL-C (dLDL-C) in identifying patients at higher risk of all-cause mortality, recurrent acute myocardial infarction (AMI), and major adverse cardiovascular event (MACE).

METHODS

A total of 9,751 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) in the Fuwai PCI registry were included. DLDL-C was measured by the selective solubilization method (Kyowa Medex, Tokyo, Japan). Correct classification was defined as the proportion of estimated LDL-C in the same category as dLDL-C based on dLDL-C levels: less than 1.4, 1.4-1.8, 1.8-2.6, 2.6-3.0, and 3.0 mmol/L or greater.

RESULTS

Underestimation of LDL-C was found in 9.7% of patients using the Martin/Hopkins equation, compared with 13.9% using the Sampson equation and 24.6% with the Friedewald equation. Cox regression analysis showed compared the correct estimation group, underestimation of LDL-C by the Martin/Hopkins equation did not reduce all-cause mortality (HR 1.26, 95% CI: 0.72-2.20, = 0.4), recurrent AMI (HR 1.24, 95% CI: 0.69-2.21, = 0.5), and MACE (HR 1.02, 95% CI: 0.83-1.26, = 0.9). Similarly, the overestimated group did not exacerbate all-cause mortality (HR 0.9, 95% CI: 0.45-1.77, = 0.8), recurrent AMI (HR 0.63, 95% CI: 0.28-1.44, = 0.3), and MACE (HR 1.07, 95% CI: 0.86-1.32, = 0.6). The results of the diabetes subgroup analysis were similar to those of the whole population.

CONCLUSION

Compared with dLDL-C measurement, misclassification by the Martin/Hopkins and Sampson equations was present in approximately 20% of patients. However, directly measured vs. calculated LDL-C did not identify any more individuals in the PCI population with increased risk of all-cause mortality, recurrent AMI, and MACE, even in high-risk patients such as those with diabetes.

摘要

背景

我们研究的目的是评估计算得出的低密度脂蛋白胆固醇（LDL-C）在识别全因死亡、复发性急性心肌梗死（AMI）和主要不良心血管事件（MACE）风险较高的患者方面是否不如直接测量的LDL-C（dLDL-C）。

方法

纳入了阜外PCI注册研究中9751例接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者。采用选择性溶解法（日本东京协和梅迪克公司）测量dLDL-C。正确分类定义为根据dLDL-C水平，估计的LDL-C与dLDL-C处于同一类别的比例：低于1.4、1.4 - 1.8、1.8 - 2.6、2.6 - 3.0以及3.0 mmol/L或更高。

结果

使用Martin/Hopkins方程时，9.7%的患者LDL-C被低估，而使用Sampson方程时为13.9%，使用Friedewald方程时为24.6%。Cox回归分析显示，与正确估计组相比，Martin/Hopkins方程低估LDL-C并未降低全因死亡率（风险比[HR] 1.26，95%置信区间[CI]：0.72 - 2.20，P = 0.4）、复发性AMI（HR 1.24，95% CI：0.69 - 2.21）、P = 0.5）和MACE（HR 1.02，95% CI：0.83 - 1.26，P = 0.9）。同样，高估组也未加重全因死亡率（HR 0.9，95% CI：0.45 - 1.77，P = 0.8）、复发性AMI（HR 0.63，95% CI：0.28 - 1.44，P = 0.3）和MACE（HR 1.07，95% CI：0.86 - 1.32，P = 0.6）。糖尿病亚组分析结果与总体人群相似。