Liu Jing, Teng Tian-Qi, Li Zheng, Hu Feng-Wang, Sha Wei-Wei, Shen Chang-Xian, Xia Yong, Zhang Yao-Jun, Liang Li
Department of Neurology, Xuzhou New Health Geriatric Hospital, Xuzhou, Jiangsu, China.
Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Front Cardiovasc Med. 2024 Dec 10;11:1471479. doi: 10.3389/fcvm.2024.1471479. eCollection 2024.
Low-Density Lipoprotein Cholesterol (LDL-C) is the primary lipid therapy target for coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). However, progression of coronary atherosclerosis occurs even LDL-C controlled well, some potentially important factors have been overlooked.
This study aims to elucidate the relationship between remnant lipoprotein particle cholesterol (RLP-C) and the progression of non-target lesions (NTLs) in patients with well-controlled lipid levels after PCI.
This retrospective study included 769 CAD patients who underwent PCI and followed up angiography within 6-24 months thereafter. Employing Multivariate Cox regression analysis, we assessed the correlation between RLP-C and NTLs progression. Based on the receiver operating characteristic curve analysis, we identified the optimal cutoff point for RLP-C, following which the patients were divided into two groups. Propensity score matching balanced confounding factors between groups, and Log-rank tests compared Kaplan-Meier curves for overall follow-up to assess NTLs progression.
Multivariate Cox analysis revealed an independent association between RLP-C and NTLs progression when LDL-C was well-controlled. Additionally, the RLP-C level of 0.555 mmol/L was determined to be the best value for predicting NTLs progression. Following propensity score matching, Kaplan-Meier curves illustrated a significantly higher cumulative rate of NTLs progression in patients with RLP-C levels ≥0.555 mmol/L compared to the others (Log-rank = 0.002). Elevated RLP-C levels were associated with high triglyceride concentrations, diabetes mellitus, and increased risk of revascularization.
This study illustrated the atherogenic impact of RLP-C in CAD patients. High RLP-C levels increased the risk of revascularization.
低密度脂蛋白胆固醇（LDL-C）是经皮冠状动脉介入治疗（PCI）后冠心病（CAD）患者的主要血脂治疗靶点。然而，即使LDL-C控制良好，冠状动脉粥样硬化仍会进展，一些潜在的重要因素被忽视了。
本研究旨在阐明PCI术后血脂水平控制良好的患者中，残余脂蛋白颗粒胆固醇（RLP-C）与非靶病变（NTLs）进展之间的关系。
这项回顾性研究纳入了769例接受PCI并在术后6至24个月内进行随访血管造影的CAD患者。采用多变量Cox回归分析，我们评估了RLP-C与NTLs进展之间的相关性。基于受试者工作特征曲线分析，我们确定了RLP-C的最佳截断点，然后将患者分为两组。倾向评分匹配平衡了组间的混杂因素，对数秩检验比较了总体随访的Kaplan-Meier曲线以评估NTLs进展。
多变量Cox分析显示，当LDL-C控制良好时，RLP-C与NTLs进展之间存在独立关联。此外，RLP-C水平0.555 mmol/L被确定为预测NTLs进展的最佳值。倾向评分匹配后，Kaplan-Meier曲线显示，RLP-C水平≥0.555 mmol/L的患者NTLs进展的累积率显著高于其他患者（对数秩=0.002）。RLP-C水平升高与高甘油三酯浓度、糖尿病和血运重建风险增加有关。
本研究阐明了RLP-C对CAD患者的致动脉粥样硬化影响。高RLP-C水平增加了血运重建的风险。
