摘要
Abstract
Objective To evaluate the influence of baseline low-density lipoprotein cholesterol(LDL-C)level and the reduction of LDL-C on the prognosis of patients undergoing percutaneous coronary intervention(PCI).Methods This study was a retrospective study.Patients with acute coronary syndrome who underwent PCI at the First Affiliated Hospital of Dalian Medical University from January 2014 to December 2019 were collected.One month after PCI,the LDL-C level was followed up and measured.Prognostic analysis was conducted for 1 026 patients with LDL-C≤1.8 mmol/L.And they were divided into the high baseline LDL-C group(HL group,n=792,baseline LDL-C>1.8 mmol/L)and the low baseline LDL-C group(LL group,n=234,baseline LDL-C≤1.8 mmol/L)according to the baseline LDL-C level at admission.Composite major adverse cardiovascular events(MACE)were set as the primary endpoint.Subgroup analysis and interaction tests were performed according to characteristics such as age,gender,and clinical manifestations.Results In the HL group,the concentrations of LDL-C decreased from baseline 2.49(2.14,2.81)mmol/L to 1-month follow-up 1.52(1.35,1.68)mmol/L,representing a 39%reduction(P<0.001).And in the LL group,the concentrations of LDL-C decreased from baseline 1.53(1.36,1.69)mmol/L to 1-month follow-up 1.37(1.20,1.57)mmol/L,representing a 10%reduction(P<0.001).The log-rank test revealed that patients in the HL group have a better prognosis than those in the LL group(P=0.009 3).Adjusted for confounders,baseline LDL-C>1.8 mmol/L was negatively related with the prevalence of MACEs and MI(HR=0.66,95%CI:0.46-0.95,P=0.027;HR=0.46,95%CI:0.22-0.93,P=0.032).Meanwhile,the interaction between diabetic patients and non-diabetic patients was comparable(Pinteraction=0.506).Patients with male,age≤65,hypertension,no hypertensive patients,patients without previous PCI,STEMI,and with estimated glomerular filtration rate>60 ml/(min·1.73 m2)showed diversely benefited from baseline LDL-C>1.8 mmol/L,similar effects were not observed in the remaining groups of patients(Pinteraction=0.897,0.682,0.603,0.875,0.428 and 0.932,respectively).Conclusions For patients with LDL-C(≤1.8 mmol/L)at 1-month follow-up after PCI,patients with baseline LDL-C levels>1.8 mmol/L show the better prognosis,which may be potentially attributable to greater LDL-C reductions.In clinical practice,stratified management of patients at different baseline levels can be used to achieve better prognosis.关键词
基线低密度脂蛋白胆固醇水平/目标低密度脂蛋白胆固醇/经皮冠状动脉介入治疗/主要心血管不良事件Key words
Baseline LDL-C levels/Targeted LDL-C/Percutaneous coronary intervention/Major adverse cardiovascular events
