脂蛋白a水平与CHD患者PCI术后1年内主要不良心血管事件的相关性

Correlation Between Lipoprotein a Level and Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease Within 1 Year After Percutaneous Coronary Intervention

【目的】探讨行经皮冠状动脉介入手术(PCI)的冠心病(CHD)患者中不同脂蛋白a[Lp(a)]水平,是否与术后1年内发生主要不良心血管事件(MACE)相关。【方法】连续选取2013-2014年在我院住院行PCI术并于1年后完成随访的CHD患者297例。记录患者1年内发生MACE情况,MACE定义为再发心绞痛入院治疗、非计划性再次血运重建、急性心肌梗死、急性左心衰竭、心源性死亡。通过单因素和多因素的生存分析比较不同Lp(a)水平的患者术后1年内MACE发生的差异。【结果】297例患者平均无事件生存时间为(11.41±2.04)月。发生MACE的患者共30例,MACE发生率为10.1%。将患者分为Lp(a)≤150 mg/L、150 mg/L<Lp(a)≤300 mg/L、Lp(a)>300 mg/L 3组,经过构建无事件生存曲线并使用Log-rank检验比较3组患者的生存曲线后发现Lp(a)>300 mg/L的患者MACE发生率较高。使用Cox风险比例回归模型进行多因素校正,作为定量变量Lp(a)升高是CHD患者PCI术后1年MACE发生的危险因素[hazard ratio(HR)per 1-SD increase 1.76,95%confidence interval(CI):1.41~2.19,P<0.001],作为分类变量Lp(a)>300 mg/L也与CHD患者PCI术后1年MACE发生正相关(HR 2.25,95%CI:1.38~3.67,P=0.001)。【结论】Lp(a)水平越高,CHD患者PCI术后1年内MACE发生率越高,Lp(a)是CHD患者PCI术后1年MACE发生的独立危险因素。

【Objective】To explore the association between lipoprotein a[Lp(a)]and major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)within 1 year after percutaneous coronary intervention(PCI).【Methods】Our study consecutively included 297 CHD patients who underwent PCI in our hospital from January 1,2013 to December 31,2014 and finished follow-up visits 1 year later.All patients were divided into 3 groups according to Lp(a)≤150mg/L,150mg/L<Lp(a)≤300mg/L and Lp(a)>300mg/L.MACE occurrences were recorded.MACE is defined as hospitalization for recurrent angina pectoris,unplanned revascularization,acute myocardial infarction,acute heart failure and cardiogenic death.The different incidences of MACE within one year after PCI between patients with different Lp(a)levels were compared by univariate and multivariate survival analysis.【Results】The average event-free survival time of 297 patients was(11.41±2.04)months.A total of 30 patients suffered from MACE,and the incidence of MACE was 10.1%.After constructing the event-free survival curves and comparing the survival rate by Log-rank test,it was found that patients with LP(a)>300mg/L had a higher incidence of MACE.Cox proportional hazards regression models were used for multivariate adjustment.As a quantitative variable,elevated Lp(a)level was risk factor of MACE occurrence in CHD patients within 1 year after PCI[hazard ratio(HR)per 1-SD increase 1.76,95%confidence interval(CI):1.41~2.19,P<0.001].As a categorical variable,Lp(a)>300mg/L was also positively correlated with MACE occurrence within in CHD patients 1 year after PCI(HR 2.25,95%CI:1.38~3.67,P=0.001).【Conclusions】The higher the level of Lp(a),the higher the incidence of MACE within 1 year after PCI in CHD patients.Lp(a)is an independent risk factor for MACE occurrence within 1 year after PCI in CHD patients.