ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后血浆校正致动脉粥样硬化指数与主要不良心血管事件的关联：一项中国的前瞻性观察研究

Association between adjusted atherogenic index of plasma and major adverse cardiovascular events after percutaneous coronary intervention in patients with STEMI: a prospective observational study in China.

作者信息

Wu Dong, Wang Xiaowu, Yang Zhenfeng, Wang Xiaoying, M A Zhen, Ma Yongkai, Li Ya, Li Guangli, Wang Xiaojuan

机构信息

Department of Pharmacy, Fuyang People's Hospital, Fuyang, China.

Department of Clinical Laboratory, The Second People's Hospital of Fuyang, Fuyang Clinical College of Infectious Diseases, Anhui Medical University, Fuyang, China.

出版信息

BMJ Open. 2025 Aug 21;15(8):e096065. doi: 10.1136/bmjopen-2024-096065.

DOI:10.1136/bmjopen-2024-096065

PMID:40840987

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12374678/

Abstract

OBJECTIVES

The atherogenic index of plasma (AIP) has been reported as a biomarker for cardiovascular disease risks and clinical outcomes. However, few studies have investigated the relationship between the AIP and major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).

DESIGN

Prospective observational study.

SETTING

Data were collected from consecutive patients with STEMI who received PCI at Fuyang People's Hospital from January 2023 to March 2024.

PATIENTS

A total of 334 patients with STEMI who underwent PCI. The adjusted AIP (aAIP) was calculated using the following formula: aAIP=log ((triglyceride/high-density lipoprotein cholesterol × 100). The patient population was divided into four groups based on the aAIP quartiles.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was MACEs, and the secondary outcomes included all-cause mortality, all-cause readmission and unplanned readmission as individual endpoints.

RESULTS

Among 334 eligible patients, 68 (20.36%) experienced MACEs during a median follow-up of 8.70 months. After adjusting for confounders, continuous aAIP was positively correlated with MACEs in all three models. Patients in Q3 and Q4 had significantly higher MACE risks than Q1 (p<0.001 for each model), but no difference was observed between Q1 and Q2 (p>0.05 for each model). Compared with Q1, Q4 had significantly increased all-cause mortality risk (Model 2: HR=12.72, 95% CI 1.39 to 76.44 and Model 3: HR=16.18, 95% CI 1.66 to 117.50). All-cause readmission risk was also higher in Q3 and Q4 (Model 3: Q3: HR=2.242, 95% CI 1.043 to 4.818, p=0.039 and Q4: HR=5.378, 95% CI 2.557 to 11.314, p<0.001). Kaplan-Meier curves showed that higher aAIP was associated with increased risks of MACEs, all-cause readmission and unplanned readmission (all log-rank p<0.0001), but not all-cause mortality (log-rank p=0.1534). No significant interactions between subgroups and the aAIP were observed (p>0.05 for interaction).

CONCLUSIONS

Higher aAIP was significantly associated with increased risks of MACEs, all-cause readmission and unplanned readmission.

摘要

目的

血浆致动脉粥样硬化指数（AIP）已被报道为心血管疾病风险和临床结局的生物标志物。然而，很少有研究调查ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后AIP与主要不良心血管事件（MACE）之间的关系。

设计

前瞻性观察性研究。

地点

收集了2023年1月至2024年3月在阜阳市人民医院接受PCI的连续STEMI患者的数据。

患者

共有334例接受PCI的STEMI患者。使用以下公式计算调整后的AIP（aAIP）：aAIP = log（甘油三酯/高密度脂蛋白胆固醇×100）。根据aAIP四分位数将患者人群分为四组。

主要和次要结局指标

主要结局为MACE，次要结局包括全因死亡率、全因再入院和计划外再入院作为单独终点。

结果

在334例符合条件的患者中，68例（20.36%）在中位随访8.70个月期间发生了MACE。在调整混杂因素后，连续aAIP在所有三个模型中均与MACE呈正相关。Q3和Q4组的患者发生MACE的风险显著高于Q1组（每个模型p<0.001），但Q1和Q2组之间未观察到差异（每个模型p>0.05）。与Q1组相比，Q4组的全因死亡风险显著增加（模型2：HR = 12.72，95%CI 1.39至76.44；模型3：HR = 16.18，95%CI 1.66至117.50）。Q3和Q4组的全因再入院风险也更高（模型3：Q3：HR = 2.242，95%CI 1.043至4.818，p = 0.039；Q4：HR = 5.378，95%CI 2.557至11.314，p<0.001）。Kaplan-Meier曲线显示，较高的aAIP与MACE、全因再入院和计划外再入院风险增加相关（所有对数秩检验p<0.0001），但与全因死亡率无关（对数秩检验p = 0.1534）。未观察到亚组与aAIP之间的显著交互作用（交互作用p>0.05）。