Cui Cai-Yan, Ye Tao, Cheng Lian-Chao, Tong Lin, Tong Lan, Zhang Zhen, Cai Lin
Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Cardiovascular Disease Research Institute of Chengdu, 82 Qinglong St., Chengdu 610031, China.
J Cardiovasc Dev Dis. 2022 Sep 23;9(10):322. doi: 10.3390/jcdd9100322.
Background: Patients with acute coronary syndrome (ACS) still have a high risk of recurrence of major adverse cardiovascular and cerebrovascular events (MACCE). However, there are rare studies on the prediction of MACCE in patients with ACS using lipoprotein a [Lp(a)] combined with fibrinogen. The aim of this study was to analyze the predictive value of Lp(a) combined with fibrinogen for the long-term prognosis of patients with ACS. Methods: 804 patients with ACS admitted to 11 tertiary general hospitals in Chengdu from January 2017 to June 2019 were included in the study. According to the Lp(a) 300 mg/L, patients were assigned to the non-high Lp(a) group and high Lp(a) group. Patients were assigned to the non-high or high fibrinogen groups using the fibrinogen level of 3.08 g/L. Subsequently, patients were divided into group A, B, or C by Lp(a) combined with fibrinogen. The study endpoints were MACCE, including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and revascularization. The incidences of MACCE among groups were compared. Lp(a), fibrinogen, Lp(a) combined with fibrinogen classifications were each added into the basic model to construct three new models. The C-index, net reclassification index (NRI) and integrated discrimination improvement (IDI) of the three new models were then compared. Results: The median follow-up was 16 months. During follow-up, the cumulative incidence of MACCE in group C was significantly higher than that measured in group A and B (p < 0.001). The results of the multivariate Cox regression analysis of MACCE showed that Lp(a) ≥300 mg/L with fibrinogen ≥3.08 g/L was an independent predictor of MACCE. According to the GRACE score and the statistical analyses, the basic model was constructed, which had a C-index of 0.694. The C-index, NRI, and IDI of the new model constructed using the basic model + Lp(a) combined with fibrinogen classification were 0.736, 0.095, and 0.094 respectively. Conclusions: Single Lp(a), single fibrinogen and Lp(a) combined with fibrinogen were independent predictors of MACCE in patients with ACS. The predictive value of Lp(a) combined with fibrinogen in patients with ACS was better than that of single Lp(a) and single fibrinogen.
急性冠状动脉综合征（ACS）患者发生重大不良心血管和脑血管事件（MACCE）的复发风险仍然很高。然而，关于使用脂蛋白a [Lp(a)]联合纤维蛋白原预测ACS患者MACCE的研究很少。本研究旨在分析Lp(a)联合纤维蛋白原对ACS患者长期预后的预测价值。方法：纳入2017年1月至2019年6月在成都11家三级综合医院收治的804例ACS患者。根据Lp(a) 300 mg/L，将患者分为非高Lp(a)组和高Lp(a)组。使用纤维蛋白原水平3.08 g/L将患者分为非高或高纤维蛋白原组。随后，根据Lp(a)联合纤维蛋白原将患者分为A、B或C组。研究终点为MACCE，包括全因死亡、非致命性心肌梗死、非致命性卒中及血运重建。比较各组MACCE的发生率。将Lp(a)、纤维蛋白原、Lp(a)联合纤维蛋白原分类分别加入基础模型构建三个新模型。然后比较三个新模型的C指数、净重新分类指数（NRI）和综合判别改善（IDI）。结果：中位随访时间为16个月。随访期间，C组MACCE的累积发生率显著高于A组和B组（p < 0.001）。MACCE的多因素Cox回归分析结果显示，Lp(a)≥300 mg/L且纤维蛋白原≥3.08 g/L是MACCE的独立预测因子。根据GRACE评分和统计分析构建基础模型，其C指数为0.694。使用基础模型+Lp(a)联合纤维蛋白原分类构建的新模型的C指数、NRI和IDI分别为0.736、0.095和0.094。结论：单一Lp(a)、单一纤维蛋白原以及Lp(a)联合纤维蛋白原均为ACS患者MACCE的独立预测因子。Lp(a)联合纤维蛋白原对ACS患者的预测价值优于单一Lp(a)和单一纤维蛋白原。
