Zhao Xiaoxiao, Song Li, Li Jiannan, Zhou Jinying, Li Nan, Yan Shaodi, Chen Runzhen, Wang Ying, Liu Chen, Zhou Peng, Sheng Zhaoxue, Chen Yi, Zhao Hanjun, Yan Hongbing
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China.
J Inflamm Res. 2023 Jan 21;16:269-282. doi: 10.2147/JIR.S389778. eCollection 2023.
This study aimed to determine whether convertase subtilisin/kexin type 9 (PCSK9)-associated cardiovascular risk is modulated by triglyceride-glucose (TyG) in ST-segment elevation myocardial infarction (STEMI) patients with primary percutaneous coronary disease (PCI).
A total of 1541 patients with STEMI (aged ≥18 years) undergoing primary PCI were consecutively enrolled between March 2017 and March 2019.
When stratifying the overall population according to TyG indices less than or greater than the median (TyG median = 9.07) as well as according to quartiles of PCSK9 levels, higher TyG index levels were significantly associated with all-cause mortality only when TyG levels were 9.07 or higher (ie, relative to quartile 1 [Q1], the adjusted HR for all-cause mortality was 3.20 [95% CI, 0.54-18.80] for Q2, = 0.199; 7.89 [95% CI, 1.56-40.89] for Q3, = 0.013; and 5.61 [95% CI, 1.04-30.30] for Q4, = 0.045. During a median follow-up period of 1.96 years, the HR for all-cause mortality was higher in the subset of patients with TyG ≥median and PCSK9 ≥median (p for trend = 0.023) among those with type 2 diabetes mellitus (T2DM). However, there were no statistically significant differences among the subgroups. Among T2DM patients with a TyG index greater than the median, the Kaplan-Meier curve showed that patients with the highest PCSK9 levels had an increased risk of all-cause mortality (log-rank = 0.017) and cardiac-cause mortality (log-rank = 0.037) compared with lower PCSK9 quartile levels.
Elevated PCSK9 levels are related to all-cause mortality and cardiac-related mortality when TyG levels are greater than the median, but not when levels are less than the median. This suggests a potential benefit of lowering circulating PCSK9 levels in STEMI patients with insulin resistance.
本研究旨在确定在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，枯草溶菌素/克新9型转化酶（PCSK9）相关的心血管风险是否受甘油三酯-葡萄糖（TyG）的调节。
2017年3月至2019年3月期间，连续纳入了1541例年龄≥18岁、接受直接PCI的STEMI患者。
根据TyG指数小于或大于中位数（TyG中位数 = 9.07）以及PCSK9水平的四分位数对总体人群进行分层时，仅当TyG水平为9.07或更高时，较高的TyG指数水平才与全因死亡率显著相关（即，相对于第一四分位数[Q1]，第二四分位数[Q2]全因死亡率的调整后风险比[HR]为3.20[95%置信区间（CI），0.54 - 18.80]，P = 0.199；第三四分位数[Q3]为7.89[95%CI，1.56 - 40.89]，P = 0.013；第四四分位数[Q4]为5.61[95%CI，1.04 - 30.30]，P = 0.045）。在中位随访期1.96年期间，在2型糖尿病（T2DM）患者中，TyG≥中位数且PCSK9≥中位数的亚组全因死亡率的HR更高（趋势P = 0.023）。然而，各亚组之间无统计学显著差异。在TyG指数大于中位数的T2DM患者中，Kaplan-Meier曲线显示，与PCSK9四分位数水平较低的患者相比，PCSK9水平最高的患者全因死亡率风险增加（对数秩检验P = 0.017），心脏原因死亡率风险增加（对数秩检验P = 0.037）。
当TyG水平大于中位数时，PCSK9水平升高与全因死亡率和心脏相关死亡率相关，但当TyG水平小于中位数时则不然。这表明在有胰岛素抵抗的STEMI患者中降低循环PCSK9水平可能有益。
