Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.

Effects of bilirubin on perioperative myocardial infarction and its long-term prognosis in patients undergoing percutaneous coronary intervention

BACKGROUND Although bilirubin is known to be an antioxidant,any relationship with coronary heart disease remains controversial.To the best of our knowledge,no previous study has investigated the association between bilirubin and perioperative myocardial infarction(PMI),including its long-term prognosis.AIM To investigate the impact of bilirubin levels on PMI in patients undergoing percutaneous coronary intervention(PCI),and long-term prognosis in post-PMI patients.METHODS Between January 2014 and September 2018,10236 patients undergoing elective PCI were enrolled in the present study.Total bilirubin(TB)and cardiac troponin I(cTnI)levels were measured prior to PCI and cTnI at further time-points,8,16 and 24 h after PCI.Participants were stratified by pre-PCI TB levels and divided into three groups:<10.2;10.2-14.4 and>14.4μmol/L.PMI was defined as producing a post-procedural cTnI level of>5×upper limit of normal(ULN)with normal baseline cTnI.Major adverse cardiovascular events(MACEs)included cardiac death,MI,stroke and revascularization during a maximum 5-year follow-up.RESULTS PMI was detected in 526(15.3%),431(12.7%)and 424(12.5%)of patients with pre-PCI TB levels of<10.2,10.2-14.4 and>14.4μmol/L(P=0.001),respectively.Multivariate logistical analysis indicated that patients with TB 10.2-14.4 and>14.4μmol/L had a lower incidence of PMI[TB 10.2-14.4μmol/L:Odds ratio(OR):0.854;95%confidence interval(CI):0.739-0.987;P=0.032;TB>14.4μmol/L:OR:0.846;95%CI:0.735-0.975;P=0.021]compared with patients with TB<10.2μmol/L.Construction of a Kaplan-Meier curve demonstrated a higher MACE-free survival time for patients with higher TB than for those with lower TB(log-rank P=0.022).After adjustment for cardiovascular risk factors and angiographic characteristics,multivariate Cox analysis showed that a TB level>14.4μmol/L was associated with a reduced risk of MACEs compared with a TB level<10.2μmol/L(hazard ratio 0.667;95%CI:0.485-0.918;P=0.013).CONCLUSION Bilirubin was a protective factor in PMI prediction.For post-PMI patients,elevated bilirubin levels were independently associated with a reduced risk of MACEs during long-term follow-up.