基线LDL-C水平与经皮冠状动脉介入治疗术后达标患者预后的关联:LDL-C降幅的重要性OA
Association between baseline LDL-C levels and prognosis in eligible patients after percutaneous coronary intervention:The importance of LDL-C reduction
目的 评估基线LDL-C水平及LDL-C降幅是否会影响经皮冠状动脉介入治疗(percutaneous coronary interven-tion,PCI)患者的预后.方法 本研究为回顾性研究,选取2014年1月至2019年12月在大连医科大学第一附属医院接受PCI的急性冠脉综合征患者.在PCI后1个月随访并检测LDL-C水平,对LDL-C≤1.8 mmol/L的1 026例患者进行预后分析.并根据入院时基线LDL-C水平将其分为高基线LDL-C组(HL组,792例,基线LDL-C>1.8 mmol/L)和低基线LDL-C组(LL组,234例,基线 LDL-C≤1.8 mmol/L).以主要心血管不良事件(major adverse cardiovascular events,MACE)为主要终点,并按年龄、性别、临床表现等特征进行分组分析和交互检验.结果 PCI术后1个月时,HL组LDL-C浓度从基线值2.49(2.14,2.81)mmol/L降至1.52(1.35,1.68)mmol/L,降幅39%(P<0.001),LL组则从基线值1.53(1.36,1.69)mmol/L降至1.37(1.20,1.57)mmol/L,降幅10%(P<0.001).对数秩检验显示,HL组患者的预后优于LL组患者(P=0.009 3).在调整了混杂因素后,基线LDL-C>1.8 mmol/L与 MACEs和心肌梗死的发生率呈负相关(HR=0.66,95%CI:0.46～0.95,P=0.027;HR=0.46,95%CI:0.22～0.93,P=0.032).糖尿病患者与非糖尿病患者之间的交互作用具有可比性(P交互=0.506).男性、年龄≤65岁、高血压、既往未行过PCI、有ST段抬高型心肌梗死和估算肾小球滤过率>60 ml/(min·1.73 m2)的患者从基线LDL-C>1.8 mmol/L中获益不同,其他患者中未观察到类似效果(P交互 分别为0.897、0.682、0.603、0.875、0.428和0.932).结论 在术后1个月LDL-C均≤1.8 mmol/L的前提下,相较于基线LDL-C≤1.8 mmol/L的患者,基线LDL-C>1.8 mmol/L的患者显示出更佳的临床预后.这可能与后者获得了更显著的LDL-C降幅有关.临床实践中可对不同基线水平患者分层管理,以期现更好预后.
Objective To evaluate the influence of baseline low-density lipoprotein cholesterol(LDL-C)level and the reduction of LDL-C on the prognosis of patients undergoing percutaneous coronary intervention(PCI).Methods This study was a retrospective study.Patients with acute coronary syndrome who underwent PCI at the First Affiliated Hospital of Dalian Medical University from January 2014 to December 2019 were collected.One month after PCI,the LDL-C level was followed up and measured.Prognostic analysis was conducted for 1 026 patients with LDL-C≤1.8 mmol/L.And they were divided into the high baseline LDL-C group(HL group,n=792,baseline LDL-C>1.8 mmol/L)and the low baseline LDL-C group(LL group,n=234,baseline LDL-C≤1.8 mmol/L)according to the baseline LDL-C level at admission.Composite major adverse cardiovascular events(MACE)were set as the primary endpoint.Subgroup analysis and interaction tests were performed according to characteristics such as age,gender,and clinical manifestations.Results In the HL group,the concentrations of LDL-C decreased from baseline 2.49(2.14,2.81)mmol/L to 1-month follow-up 1.52(1.35,1.68)mmol/L,representing a 39%reduction(P<0.001).And in the LL group,the concentrations of LDL-C decreased from baseline 1.53(1.36,1.69)mmol/L to 1-month follow-up 1.37(1.20,1.57)mmol/L,representing a 10%reduction(P<0.001).The log-rank test revealed that patients in the HL group have a better prognosis than those in the LL group(P=0.009 3).Adjusted for confounders,baseline LDL-C>1.8 mmol/L was negatively related with the prevalence of MACEs and MI(HR=0.66,95%CI:0.46-0.95,P=0.027;HR=0.46,95%CI:0.22-0.93,P=0.032).Meanwhile,the interaction between diabetic patients and non-diabetic patients was comparable(Pinteraction=0.506).Patients with male,age≤65,hypertension,no hypertensive patients,patients without previous PCI,STEMI,and with estimated glomerular filtration rate>60 ml/(min·1.73 m2)showed diversely benefited from baseline LDL-C>1.8 mmol/L,similar effects were not observed in the remaining groups of patients(Pinteraction=0.897,0.682,0.603,0.875,0.428 and 0.932,respectively).Conclusions For patients with LDL-C(≤1.8 mmol/L)at 1-month follow-up after PCI,patients with baseline LDL-C levels>1.8 mmol/L show the better prognosis,which may be potentially attributable to greater LDL-C reductions.In clinical practice,stratified management of patients at different baseline levels can be used to achieve better prognosis.
许珂;吕海辰;于尧
大连医科大学附属第一医院心血管内科,辽宁 大连 116011大连医科大学附属第一医院心血管内科,辽宁 大连 116011大连医科大学附属第一医院心血管内科,辽宁 大连 116011
基线低密度脂蛋白胆固醇水平目标低密度脂蛋白胆固醇经皮冠状动脉介入治疗主要心血管不良事件
Baseline LDL-C levelsTargeted LDL-CPercutaneous coronary interventionMajor adverse cardiovascular events
《中国医学前沿杂志（电子版）》 2026 (2)
35-43,9
评论