Lim Kevin, Wong Chris Ho Ming, Lee Angel Lok Yiu, Fujikawa Takuya, Wong Randolph Hung Leung
Division of Cardiothoracic Surgery, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong.
JTCVS Open. 2022 Feb 23;10:195-203. doi: 10.1016/j.xjon.2022.02.022. eCollection 2022 Jun.
Statins have been shown to delay the inevitable progression of atherosclerosis in native coronaries and saphenous vein grafts, thereby reducing ischemic events after surgical coronary revascularization. However, there is significant controversy as to whether titrating statin therapy to concrete cholesterol targets is appropriate.
A single-center retrospective analysis of 309 consecutive patients who underwent isolated coronary artery bypass graft in 2007 and 2008 was performed. Measurements of lipid profile subcomponents, namely total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides, in mmol/L, were obtained by retrospective review of electronic health records. The primary end point was cardiac death. The secondary end point was the composite of cardiac events, including cardiac death, nonfatal myocardial infarction, hospitalization for unstable angina, and target lesion revascularization. Database lock date was August 15, 2020.
The median follow-up duration was 12.5 years. Cardiac death occurred in 6.8% of the cohort. Cardiac events occurred in 21.7% of the cohort. New-onset myocardial infarction occurred in 8.7% (n = 27), of which 48.1% (n = 13) underwent repeat revascularization. A 2-level nested Cox proportional hazards regression model was constructed to determine whether cholesterol target attainment was independently associated with cardiac events. After risk adjustment, LDL-C, non-HDL-C, total cholesterol (TC), and TC/HDL-C ratio were independently associated with cardiac death. In receiver operating characteristics analyses, the optimal cut-off values for non-HDL-C, LDL-C, and TC/HDL-C ratio were 3.2 mmol/L, 2.3 mmol/L, and 3.5, respectively.
Exposure to elevated LDL-C and non-HDL-C cholesterol levels independently predicted long-term cardiac death after coronary artery bypass graft.
他汀类药物已被证明可延缓自身冠状动脉和隐静脉移植物中动脉粥样硬化的不可避免进展，从而减少冠状动脉血运重建术后的缺血事件。然而，对于将他汀类药物治疗调整至具体的胆固醇目标是否合适存在重大争议。
对2007年和2008年连续309例行单纯冠状动脉旁路移植术的患者进行单中心回顾性分析。通过回顾电子健康记录，以mmol/L为单位测量血脂亚组分，即总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和甘油三酯。主要终点是心源性死亡。次要终点是心脏事件的复合终点，包括心源性死亡、非致命性心肌梗死、不稳定型心绞痛住院和靶病变血运重建。数据库锁定日期为2020年8月15日。
中位随访时间为12.5年。该队列中心源性死亡发生率为6.8%。心脏事件发生率为21.7%。新发心肌梗死发生率为8.7%（n = 27），其中48.1%（n = 13）接受了再次血运重建。构建了一个两级嵌套Cox比例风险回归模型，以确定达到胆固醇目标是否与心脏事件独立相关。经过风险调整后，LDL-C、非HDL-C、总胆固醇（TC）和TC/HDL-C比值与心源性死亡独立相关。在受试者工作特征分析中，非HDL-C、LDL-C和TC/HDL-C比值的最佳截断值分别为3.2 mmol/L、2.3 mmol/L和3.5。
暴露于升高的LDL-C和非HDL-C胆固醇水平可独立预测冠状动脉旁路移植术后的长期心源性死亡。
