急性冠状动脉综合征患者药物洗脱支架植入术后的血脂谱与新动脉粥样硬化的危险因素
Lipid profile and risk factors for neoatherosclerosis after drug-eluting stent implantation in acute coronary syndrome.
作者信息
Nakamura Norihito, Sakai Katsuaki, Torii Sho, Aoki Yuki, Turcotte-Gosselin Frederic, Fujinuma Kazuki, Ohwaki Ami, Aihara Kazuki, Noda Satoshi, Miyamoto Junichi, Sato Yu, Shiozaki Manabu, Natsumeda Makoto, Ohno Yohei, Nakano Masataka, Yoshimachi Fuminobu, Nakazawa Gaku, Ikari Yuji
机构信息
Tokai University School of Medicine, Department of Cardiology, Isehara, Japan (Drs Nakamura, Torii, Aoki, Turcotte-Gosselin, Aihara, Noda, Miyamoto, Sato, Shiozaki, Natsumeda, Ohno, and Ikari).
Nagasaki Heart Clinic, Nagasaki, Japan (Dr Sakai).
出版信息
J Clin Lipidol. 2024 Nov-Dec;18(6):e977-e985. doi: 10.1016/j.jacl.2024.08.011. Epub 2024 Aug 31.
BACKGROUND
Predictors of neoatherosclerosis in patients who received primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain unclear.
OBJECTIVE
The aim of this study is to investigate the frequency and risk factors of neoatherosclerosis 1-year after the onset of ACS.
METHODS
This study investigated 83 patients who underwent PCI for ACS followed by 1-year follow-up optical coherence tomography. The patients were categorized into the neoatherosclerosis (n = 11) and non-neoatherosclerosis groups (n = 72). Baseline characteristics, PCI procedures, medical therapies, and blood tests at 1-year, including detailed lipid profiles, were compared between the two groups.
RESULTS
Diabetes mellitus was more prominent in the neoatherosclerosis than in the non-neoatherosclerosis group (45% vs. 17%, respectively, p = 0.03). Total cholesterol (171 ± 37 mg/dL vs. 145 ± 25 mg/dL, respectively, p < 0.01), non-high-density lipoprotein cholesterol (non-HDL-C) (124 ± 36 mg/dL vs. 94 ± 24 mg/dL, respectively, p < 0.01), low-density lipoprotein cholesterol (94 ± 36 mg/dL vs. 72 ± 19 mg/dL, respectively, p < 0.01), and lipoprotein (a) (Lp[a]) (70 [19-112] mg/dL vs. 10 [3-25] mg/dL, respectively, p = 0.03) at follow-up were significantly higher in the neoatherosclerosis group. Multivariate analysis revealed that neoatherosclerosis was associated with high serum non-HDL-C (odds ratio [OR]: 1.075; 95% confidence interval [CI]: 1.011-1.144; p < 0.01) and high serum Lp(a) levels (> 30 mg/dL) (OR: 11.0; 95% CI: 1.492-81.02; p = 0.02).
CONCLUSION
Poorly controlled non-HDL-C and Lp(a) would be risk factors of neoatherosclerosis in patients 1-year after ACS.
背景
对于因急性冠状动脉综合征（ACS）接受直接经皮冠状动脉介入治疗（PCI）的患者，新生动脉粥样硬化的预测因素仍不明确。
目的
本研究旨在调查ACS发病1年后新生动脉粥样硬化的发生率及危险因素。
方法
本研究纳入了83例行PCI治疗的ACS患者，并对其进行了为期1年的光学相干断层扫描随访。将患者分为新生动脉粥样硬化组（n = 11）和非新生动脉粥样硬化组（n = 72）。比较两组的基线特征、PCI手术情况、药物治疗及1年时的血液检查结果，包括详细的血脂谱。
结果
新生动脉粥样硬化组的糖尿病更为突出（分别为45%和17%，p = 0.03）。随访时，新生动脉粥样硬化组的总胆固醇（分别为171±37mg/dL和145±25mg/dL，p < 0.01）、非高密度脂蛋白胆固醇（non-HDL-C）（分别为124±36mg/dL和94±24mg/dL，p < 0.01）、低密度脂蛋白胆固醇（分别为94±36mg/dL和72±19mg/dL，p < 0.01）和脂蛋白（a）[Lp（a）]（分别为70[19 - 112]mg/dL和10[3 - 25]mg/dL，p = 0.03）均显著高于非新生动脉粥样硬化组。多因素分析显示，新生动脉粥样硬化与高血清non-HDL-C（比值比[OR]：1.075；95%置信区间[CI]：1.011 - 1.144；p < 0.01）及高血清Lp（a）水平（> 30mg/dL）（OR：11.0；95%CI：1.492 - 81.02；p = 0.02）相关。
结论
ACS发病1年后，non-HDL-C和Lp（a）控制不佳可能是新生动脉粥样硬化的危险因素。
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