残余胆固醇对急性冠脉综合征合并/不合并糖尿病患者远期预后的影响

Effect of Residual Cholesterol on Long-Term Prognosis in Patients with Acute Coronary Syndrome with or without Diabetes Mellitus

目的 探究残余胆固醇对急性冠脉综合征(ACS)合并或不合并糖尿病患者远期预后的影响。方法 纳入2017年1月—2019年6月于成都市11家医院就诊的ACS患者,根据是否合并糖尿病分为非糖尿病组和糖尿病组。再根据残余胆固醇水平(临界值0.8 mmol/L)分为残余胆固醇<0.8 mmol/L和残余胆固醇≥0.8 mmol/L两个亚组。进行随访,观察其主要不良心脑血管事件(MACCE),包括全因死亡、非致死性心肌梗死、非致死性脑卒中和再次血运重建事件的发生率。分别在非糖尿病和糖尿病患者中,比较残余胆固醇<0.8 mmol/L和残余胆固醇≥0.8 mmol/L两组在随访期间MACCE发生率。结果 本研究纳入ACS患者1 568例:非糖尿病患者1 162例,其中残余胆固醇<0.8 mmol/L组954例,残余胆固醇≥0.8 mmol/L组208例;糖尿病患者406例,其中残余胆固醇<0.8 mmol/L组311例,残余胆固醇≥0.8 mmol/L组95例。中位随访时间为14个月(8个月,21个月)。多因素Cox回归分析显示:非糖尿病患者中,残余胆固醇≥0.8 mmol/L是ACS患者MACCE发生的独立预测因子(HR=1.786,95%CI 1.031~3.094,P=0.039);在糖尿病患者中,残余胆固醇≥0.8 mmol/L不是ACS患者MACCE发生的独立预测因子(HR=0.962,95%CI 0.486~1.904,P=0.912)。结论 残余胆固醇是ACS不合并糖尿病患者远期不良预后的独立预测因子,并不是ACS合并糖尿病患者远期不良预后的独立预测因子。

Objective To investigate the impact of residual cholesterol on the long-term prognosis of patients with acute coronary syndrome(ACS).Methods ACS patients treated at 11 hospitals in Chengdu from January 2017 to June 2019 were included in the study.Patients were divided into non-diabetic group and diabetic group based on whether they had diabetes mellitus.Subquently they were devided into residual cholesterol<0.8 mmol/L and residual cholesterol≥0.8 mmol/L subgroups based on residual cholesterol levels(threshold 0.8 mmol/L).The study endpoints were major adverse cardiovascular and cerebrovascular events(MACCE),including all-cause death,non-fatal myocardial infarction,non-fatal stroke,and revascularization.The incidence of MACCE in the residual cholesterol<0.8 mmol/L group and residual cholesterol≥0.8 mmol/L group were compared.Results Our study included 1568 ACS patients,of whom 1162 patients were non-diabetic patients.Among them,954 patients were in the residual cholesterol<0.8 mmol/L group,and 208 patients were in the residual cholesterol≥0.8 mmol/L group.There were 406 diabetic patients,with 311 patients in the residual cholesterol<0.8 mmol/L group and 95 patients in the residual cholesterol≥0.8 mmol/L group.The median follow-up time was 14 months(8,21 months).In non-diabetic patients,residual cholesterol≥0.8 mmol/L was an independent predictor of MACCE in ACS patients(HR=1.786,95%CI 1.031~3.094,P=0.039).However,in diabetic patients,residual cholesterol≥0.8 mmol/L was not an independent predictor of MACCE in ACS patients(HR=0.962,95%CI 0.486~1.904,P=0.912).Conclusion High level residual cholesterol is an independent predictor of long-term poor prognosis in ACS patients without diabetes mellitus,but not in ACS patients with diabetes mellitus.