Quan Weiwei, Han Hui, Liu Lili, Sun Yi, Zhu Zhengbin, Du Run, Zhu Tianqi, Zhang Ruiyan
Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Department of Cardiovascular Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
J Clin Med. 2023 Jan 18;12(3):785. doi: 10.3390/jcm12030785.
The progression of NTLs after PCI accounts for a significant portion of future adverse cardiac events. The reduction in LDL-C reduces cardiovascular events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes with progression in NTLs. A total of 847 patients with successful PCI were enrolled. Patients with follow-up LDL-C ≥ 1.4 mmol/L or percent reduction <50% compared to baseline were Non-optimal group ( = 793); patients with follow-up LDL-C < 1.4 mmol/L and percent reduction ≥50% compared to baseline were Optimal group ( = 54). Compared to Non-optimal group, Optimal group presented a lower rate of NTL plaque progression (11.11% vs. 23.96%; = 0.007) and a lower follow-up TC (2.77 ± 0.59 vs. 3.66 ± 0.97; < 0.001) and LDL-C (1.09 ± 0.26 vs. 2.03 ± 0.71; < 0.001). The univariate logistic regression analysis revealed that follow-up LDL-C < 1.4 mmol/L and a percent reduction ≥50% from baseline was a protective factor for NTL plaque progression (OR: 0.397; 95%CI: 0.167-0.941; = 0.036). The multivariate logistic regression model revealed that follow-up LDL-C < 1.4 mmol/L and percent reduction ≥50% was indeed an independent factor associated with a lower rate of plaque progression of NTLs (OR: 0.398; 95% CI: 0.167-0.945; = 0.037). Therefore, achieving guideline-recommended LDL-C level was associated with a significantly reduced risk of NTL plaque progression.
PCI术后非靶病变（NTLs）的进展在未来不良心脏事件中占很大一部分。低密度脂蛋白胆固醇（LDL-C）的降低可减少心血管事件。然而，这一点在现实世界中尚未得到证实。我们旨在研究LDL-C变化与NTLs进展之间的关联。共纳入847例PCI成功的患者。随访时LDL-C≥1.4 mmol/L或与基线相比降低百分比<50%的患者为非最佳组（n = 793）；随访时LDL-C<1.4 mmol/L且与基线相比降低百分比≥50%的患者为最佳组（n = 54）。与非最佳组相比，最佳组的NTL斑块进展率较低（11.11%对23.96%；P = 0.007），随访时总胆固醇（TC）较低（2.77±0.59对3.66±0.97；P<0.001），LDL-C较低（1.09±0.26对2.03±0.71；P<0.001）。单因素逻辑回归分析显示，随访时LDL-C<1.4 mmol/L且与基线相比降低百分比≥50%是NTL斑块进展的保护因素（比值比：0.397；95%置信区间：0.167 - 0.941；P = 0.036）。多因素逻辑回归模型显示，随访时LDL-C<1.4 mmol/L且降低百分比≥50%确实是与较低的NTL斑块进展率相关的独立因素（比值比：0.398；95%置信区间：0.167 - 0.945；P = 0.037）。因此，达到指南推荐的LDL-C水平与NTL斑块进展风险显著降低相关。
