Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, China.
Technol Health Care. 2024;32(5):3317-3328. doi: 10.3233/THC-240005.
BACKGROUND: Despite the considerable progress made in preventative methods, medication, and interventional therapies, it remains evident that cardiovascular events (CVEs) continue to be the primary cause of both death and morbidity among individuals diagnosed with coronary artery disease (CAD). OBJECTIVE: To compare the connection between lipoprotein a (Lp[a]), fibrinogen (Fib), and both parameters combined with all-cause mortality to detect their value as prognostic biomarkers. METHODS: This is a retrospective study. Patients diagnosed with CAD between January 2007 and December 2020 at the Guangdong Provincial People's Hospital (China) were involved in the study. 43,367 patients met the eligibility criteria. The Lp(a) and Fib levels were distributed into three tertile groups (low, medium, and high). All of the patients included in the study were followed up for all-cause mortality. Kaplan-Meier and Cox regression were performed to determine the relationship between Lp(a), Fib, and all-cause mortality. A concordance statistics model was developed to detect the impact of Fib and Lp(a) in terms of anticipating poor outcomes in patients with CAD. RESULTS: Throughout a median follow-up of 67.0 months, 6,883 (15.9%) patients died. Participants with high Lp(a) (above 27.60 mg/dL) levels had a significantly higher risk for all-cause mortality than individuals with low Lp(a) levels (below 11.13 mg/dL; adjusted hazard ratio [aHR] 1.219, 95% confidence interval [CI]: 1.141-1.304, p< 0.001). Similarly, patients with high Fib levels (above 4.32 g/L) had a significantly greater risk of developing all-cause mortality compared with those with reduced Fib levels (below 3.41 g/L; aHR 1.415, 95% CI: 1.323-1.514, p< 0.001). Patients with raised Lp(a) and Fib levels had the maximum risk for all-cause mortality (aHR 1.702; 95% CI: 1.558-1.859, p< 0.001). When considered together, Lp(a) and Fib caused a significant elevation of the concordance statistic by 0.009 (p< 0.05), suggesting a higher value for predicting mortality when combining the two indicators. CONCLUSION: High Lp(a) and Fib levels could be used as predictive biomarkers for all-cause mortality in individuals with CAD. The prediction accuracy for all-cause mortality improved after combining the two parameters.
背景：尽管在预防方法、药物和介入治疗方面取得了相当大的进展，但心血管事件 (CVE) 仍然是冠心病 (CAD) 患者死亡和发病的主要原因。
目的：比较脂蛋白 a (Lp[a])、纤维蛋白原 (Fib) 以及这两个参数与全因死亡率之间的关系，以检测它们作为预后生物标志物的价值。
方法：这是一项回顾性研究。纳入 2007 年 1 月至 2020 年 12 月期间在广东省人民医院（中国）诊断为 CAD 的患者。符合条件的患者有 43367 名。将 Lp(a)和 Fib 水平分为三个三分位组（低、中、高）。所有纳入研究的患者均进行全因死亡率随访。通过 Kaplan-Meier 和 Cox 回归分析确定 Lp(a)、Fib 与全因死亡率之间的关系。建立了一个一致性统计模型，以检测 Fib 和 Lp(a)在预测 CAD 患者不良预后方面的影响。
结果：在中位随访 67.0 个月期间，6883 名（15.9%）患者死亡。与 Lp(a)水平较低（<11.13 mg/dL）的患者相比，Lp(a)水平较高（>27.60 mg/dL）的患者全因死亡率风险显著增加（调整后的危险比 [aHR] 1.219，95%置信区间 [CI]：1.141-1.304，p<0.001）。同样，Fib 水平较高（>4.32 g/L）的患者全因死亡率风险明显高于 Fib 水平较低（<3.41 g/L）的患者（aHR 1.415，95%CI：1.323-1.514，p<0.001）。Lp(a)和 Fib 水平升高的患者全因死亡率风险最高（aHR 1.702；95%CI：1.558-1.859，p<0.001）。同时考虑 Lp(a)和 Fib 时，一致性统计量显著升高 0.009（p<0.05），表明联合这两个指标预测死亡率的价值更高。
结论：高 Lp(a)和 Fib 水平可作为 CAD 患者全因死亡率的预测生物标志物。联合这两个参数可提高全因死亡率的预测准确性。
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