高密度脂蛋白胆固醇水平降低对非ST段抬高型急性冠状动脉综合征介入治疗预后的影响

Long-term prognostic significance of high-density lipoprotein levels in patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention

目的评价高密度脂蛋白胆固醇（HDL-C）水平对非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者冠状动脉介入治疗（PCI）结果的影响。方法2006年1月到2007年1月409例因NSTE-ACS行PCI的患者中,220例HDL-C≥40 mg/dL（HDL-C正常组）,189例HDL-C〈40 mg/dL（HDL-C降低组）。收集临床和冠状动脉造影资料并对其进行随访。结果HDL-C正常组C型病变数（18.6%比28.6%,P=0.02）、无复流发生率（1.4%比5.3%,P=0.02）显著低于HDL-C降低组。平均2年随访发现,HDL-C正常组病死率（2.3%比7.9%,P=0.01）、靶病变重建率（3.6%比9.0%,P=0.02）、靶血管重建率（5.0%比10.6%,P=0.03）显著低于HDL-C降低组。Cox多因素回归分析显示,HDL-C减低是NSTE-ACS患者死亡的独立危险因素之一（RR2.18,95%CI1.21-4.93,P=0.02）。生存分析表明,随访期间HDL-C正常组累积生存率高于HDL-C降低组（97.7%比89.9%,P=0.01）。结论HDL-C水平降低与冠心病心脏事件密切相关,对PCI术后疗效产生不良影响。

Objective To assess the significance of high-density lipoprotein cholesterol （HDL-C） levels in patients with non-ST-elevation acute coronary syndrome （NSTE-ACS） undergoing percutaneous coronary intervention （PCI）. Methods In a group of 409 patients with NSTE-ACS undergoing PCI admitted during January 2006 to January 2007, 220 patients had HDL-C ≥40 mg/dL （ normal HDL-C group） and the remaining 189 had HDL-C 〈 40 mg/dL （reduced HDL-C group）. Investigation and points were death, new myocardial infarction, target lesion revascularization （TLR） and target vessel revascularization （TVR）. The relation between HDL-C and the above end points was testified. All the patients were followed up for a mean period of 23.9 ± 4.9 months. Results Compared with patients with normal HDL-C levels, patients in the lower HDL-C group were found more often to have type C lesion （18.6% vs28.6%, P=0.02） andno-reflow （1.4% vs5.3%, P=0.02）. Mortality（7.9% vs2.3%,P =0.01）, TLR （9.0% vs 3.6%,P=0.02）, and TVR （10.6% vs 5.0%,P=0.03） were significantly higher in the lower HDL-C group than in the normal HDL-C group. Multivariate Cox regression analysis showed that lower HDL-C level （RR 2. 18, 95% confidence interval 1.21 to 4. 98, P = 0. 02） was an important predictor of death. Kaplan-Meier survival curve indicated that patients with normal HDL-C levels had a higher survival rate than those with lower HDL-C levels during follow-up（97.7% vs 89. 9% , P = 0. 01 ）. Conclusion Low HDL-C levels exert a worsening effect on major adverse cardiac events in patients with NSTE-ACS undergoing PCI.