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风险因素对已干预和未干预冠状动脉病变的影响。

Impact of risk factors on intervened and non-intervened coronary lesions.

作者信息

Sheng Xincheng, Yang Gan, Zhang Qing, Zhou Yong, Pu Jun

机构信息

Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China.

出版信息

Am J Cardiovasc Dis. 2024 Aug 25;14(4):255-266. doi: 10.62347/XTBG3549. eCollection 2024.

Abstract

INTRODUCTION

In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are two pivotal aspects of disease progression in patients with coronary artery disease (CAD). Established risk factors for both include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking. However, there is limited research on the comparative risk factors for the progression of these two aspects of progression. The aim of this study was to analyze and compare the different impacts of identical risk factors on ISR and ANL.

METHODS

This study enrolled a total of 510 patients with multiple coronary artery lesions who underwent repeated coronary angiography (CAG). All patients had previously undergone percutaneous coronary intervention (PCI) and presented non-intervened coronary lesions in addition to the previously intervened vessels.

RESULTS

After data analysis, it was determined that HbA1c (OR 1.229, 95% CI 1.022-1.477, P=0.028) and UA (OR 1.003, 95% CI 1.000-1.005, P=0.024) were identified as independent risk factors for ISR. Furthermore, HbA1c (OR 1.215, 95% CI 1.010-1.460, P=0.039), Scr (OR 1.007, 95% CI 1.003-1.017, P=0.009), and ApoB (OR 1.017, 95% CI 1.006-1.029, P=0.004) were identified as independent risk factors for ANL. The distribution of multiple blood lipid levels differed between the ANL only group and the ISR only group. Non-HDL-C (2.17 mmol/L vs. 2.44 mmol/L, P=0.007) and ApoB (63.5 mg/dL vs. 71.0 mg/dL, P=0.011) exhibited significantly higher values in the ANL only group compared to the ISR only group.

CONCLUSIONS

Blood glucose levels and chronic kidney disease were identified as independent risk factors for both ISR and ANL, while elevated lipid levels were only significantly associated with ANL. In patients with non-intervened coronary lesions following PCI, it is crucial to assess the concentration of non-HDL-C and ApoB as they serve as significant risk factors.

摘要

引言

支架内再狭窄(ISR)和未干预冠状动脉病变加重(ANL)是冠心病(CAD)患者疾病进展的两个关键方面。两者已确定的危险因素包括高脂血症、高血压、糖尿病、慢性肾脏病和吸烟。然而,关于这两个进展方面的比较危险因素的研究有限。本研究的目的是分析和比较相同危险因素对ISR和ANL的不同影响。

方法

本研究共纳入510例患有多处冠状动脉病变且接受了重复冠状动脉造影(CAG)的患者。所有患者此前均接受过经皮冠状动脉介入治疗(PCI),除了先前干预的血管外,还存在未干预的冠状动脉病变。

结果

数据分析后确定,糖化血红蛋白(HbA1c)(比值比[OR]1.229,95%置信区间[CI]1.022 - 1.477,P = 0.028)和尿酸(UA)(OR 1.003,95% CI 1.000 - 1.005,P = 0.024)被确定为ISR的独立危险因素。此外,HbA1c(OR 1.215,95% CI 1.010 - 1.460,P = 0.039)、血清肌酐(Scr)(OR 1.007,95% CI 1.003 - 1.017,P = 0.009)和载脂蛋白B(ApoB)(OR 1.017,95% CI 1.006 - 1.029,P = 0.004)被确定为ANL的独立危险因素。仅ANL组和仅ISR组的多种血脂水平分布不同。仅ANL组的非高密度脂蛋白胆固醇(Non-HDL-C)(2.17 mmol/L对2.44 mmol/L,P = 0.007)和ApoB(63.5 mg/dL对71.0 mg/dL,P = 0.011)的值显著高于仅ISR组。

结论

血糖水平和慢性肾脏病被确定为ISR和ANL的独立危险因素,而血脂升高仅与ANL显著相关。在PCI术后有未干预冠状动脉病变的患者中,评估Non-HDL-C和ApoB的浓度至关重要,因为它们是重要的危险因素。

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