脂蛋白(a)水平与缺血性心脏病患者支架术后新发心房颤动的相关性研究

Correlation of lipoprotein(a)with new-onset atrial fibrillation in patients with ischemic heart disease undergoing percutaneous coronary stent implantation

目的:心房颤动(atrial fibrillation,AF)与脂蛋白(a)[lipoprotein(a),Lp(a)]密切相关。PCI术是缺血性心脏病(ischemic heart disease,IHD)的重要治疗方式,但术后新发心房颤动(new-onset atrial fibrillation,NOAF)是常见并发症之一。然而,目前尚缺乏Lp(a)水平与IHD患者行PCI术后NOAF相关性的研究。故本研究旨在探索IHD患者行PCI术后Lp(a)水平对NOAF发生的影响。方法:本研究为回顾性队列研究,最终入选IHD行PCI术的患者522例。所有患者根据基线Lp(a)水平的三分位间距分为3组。研究终点为NOAF。随访时间为3年。使用生存分析评估3组患者NOAF的发生率,绘制Kaplan-Meier曲线,计算Log-rank P。多因素Cox比例风险回归模型用于分析IHD患者行PCI术后基线Lp(a)水平与NOAF发生风险的关系,结果以风险比(hazard ratio,HR)和95%置信区间(confidence interval,CI)表示。限制性立方样条(restricted cubic spline,RCS)函数用于检验Lp(a)与NOAF之间的非线性关系。结果:随着基线Lp(a)水平增加,NOAF的发生率显著增加(P=0.026)。Kaplan-Meier曲线同样表明:随着基线Lp(a)水平增加,NOAF的发生率显著增加(Log-rank P=0.024)。Cox回归分析模型表明,随着基线Lp(a)水平的增加,患者NOAF(组1作为参考;组2 HR,95%CI:1.66,0.76~3.66,P=0.207;组3 HR,95%CI:2.93,1.44~5.97,P=0.003)的发生风险显著增加。RCS曲线表明,Lp(a)与NOAF结局之间呈非线性关系,NOAF发生风险随着Lp(a)的增加而增加(非线性P值<0.001)。结论:在IHD行冠状动脉PCI术的患者中,随着Lp(a)水平增加,NOAF发生率显著升高,且二者呈非线性关系。Lp(a)水平同时也是该人群NOAF的独立预测因素。本研究结果仍需在前瞻性研究中得到进一步证实。

Objective:Atrial fibrillation(AF)is closely associated with lipoprotein(a)[Lp(a)].Percutaneous coronary stent implantation is an important treatment for ischemic heart disease(IHD),but new-onset atrial fibrillation(NOAF)is one of the common complications after the procedure.However,there is currently a lack of research on the correlation between Lp(a)levels and NOAF in IHD patients undergoing coronary stent implantation.Therefore,this study aims to explore the impact of Lp(a)levels on the occurrence of NOAF in IHD patients after coronary stent implantation.Methods:This was a retrospective cohort study,and 522 patients were finally enrolled after coronary stent implantation for IHD.All patients were divided into three groups according to the inter-quartile spacing of baseline Lp(a)levels.The study endpoint was new onset AF.follow-up was 3 years.The incidence of new-onset AF in the three groups was assessed using survival analysis,Kaplan-Meier curves were plotted,and Log-rank P was calculated.the association between baseline Lp(a)levels and new-onset AF in patients with IHD after coronary stent implantation was assessed using multifactorial Cox regression analysis,and the results were expressed using hazard ratios(HR)and 95%confidence intervals(CI).Restricted cubic spline(RCS)was used to test the nonlinear relationship between Lp(a)and new-onset AF.Results:The incidence of new-onset AF increased significantly with increasing baseline Lp(a)levels(P=0.026).Kaplan-Meier curves similarly showed that the incidence of new-onset AF increased significantly with increasing baseline Lp(a)levels(Log-rank P=0.024).Cox regression analysis models showed that with increasing baseline Lp(a)levels,patients with new-onset AF(group 1 as reference;group 2 HR,95%CI:1.66,0.76-3.66,P=0.207;group 3 HR,95%CI:2.93,1.44-5.97,P=0.003)had a significantly increased risk of developing new-onset AF(group 1 as reference;group 2 HR,95%CI:1.66,0.76-3.66,P=0.207;group 3 HR,95%CI:2.93,1.44-5.97,P=0.003).The RCS curves showed a non-linear relationship between Lp(a)and new-onset AF outcome,with the risk of developing new-onset AF increasing with Lp(a)increased with increasing Lp(a)(nonlinear P value<0.001).Conclusions:In patients undergoing coronary stent implantation for IHD,the incidence of new-onset AF increased significantly with increasing Lp(a)levels,and there was a nonlinear relationship between the two.The results of this study still need to be further confirmed in a prospective study.