Li Qiu-Xuan, Ma Xiao-Teng, Shao Qiao-Yu, Yang Zhi-Qiang, Liang Jing, Yang Li-Xia, Shi Dong-Mei, Zhou Yu-Jie, Wang Zhi-Jian
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China.
J Geriatr Cardiol. 2022 Dec 28;19(12):949-959. doi: 10.11909/j.issn.1671-5411.2022.12.001.
To determine the association of serum complement C1q levels with cardiovascular outcomes among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), and evaluate the value of C1q modified by high-sensitivity C-reactive protein (hs-CRP) levels as an independent predictor.
As a single-center prospective observational study, we analyzed 1701 patients who had received primary or elective PCI for ACS at Beijing Anzhen Hospital, Capital Medical University, Beijing, China between June 1, 2016 and November 30, 2017. The associations of C1q modified by hs-CRP with major adverse cardiovascular events (MACE) were determined in survival analysis.
Patients with the lowest C1q tertile had the highest cumulative risk of MACE (log-rank = 0.007). In fully adjusted Cox regression models, stratifying the total population according to hs-CRP dichotomy, C1q was significantly associated with MACE in patients with hs-CRP levels less than 2 mg/L but not in those with 2 mg/L or more ( = 0.02). In patients with hs-CRP levels less than 2 mg/L, with the lowest C1q tertile as reference, the risk of MACE was reduced by 40.0% in the middle C1q tertile [hazard ratio (HR) = 0.600, 95% CI: 0.423-0.852, = 0.004] and by 43.9% in the highest C1q tertile (HR = 0.561, 95% CI: 0.375-0.840, = 0.005).
Serum complement C1q is significantly associated with cardiovascular outcomes in patients with ACS undergoing PCI, only when hs-CRP levels are less than 2 mg/L. This finding implicates the usefulness of C1q for the risk stratification in ACS patients with reduced systemic inflammation.
确定接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者血清补体C1q水平与心血管结局之间的关联，并评估经高敏C反应蛋白（hs-CRP）水平修正的C1q作为独立预测因子的价值。
作为一项单中心前瞻性观察性研究，我们分析了2016年6月1日至2017年11月30日期间在中国北京首都医科大学附属北京安贞医院接受ACS初次或择期PCI治疗的1701例患者。在生存分析中确定经hs-CRP修正的C1q与主要不良心血管事件（MACE）之间的关联。
C1q三分位数最低的患者发生MACE的累积风险最高（对数秩检验=0.007）。在完全调整的Cox回归模型中，根据hs-CRP二分法对总体人群进行分层，C1q在hs-CRP水平低于2mg/L的患者中与MACE显著相关，而在hs-CRP水平为2mg/L或更高的患者中则不然（P=0.02）。在hs-CRP水平低于2mg/L的患者中，以C1q三分位数最低者为参照，C1q三分位数居中者发生MACE的风险降低40.0%[风险比（HR）=0.600，95%可信区间（CI）：0.423-0.852，P=0.004]，C1q三分位数最高者降低43.9%（HR=0.561，95%CI：0.375-0.840，P=0.005）。
仅当hs-CRP水平低于2mg/L时，血清补体C1q才与接受PCI的ACS患者的心血管结局显著相关。这一发现表明C1q对全身炎症减轻的ACS患者进行风险分层有用。
