Associations between lipid profiles and MACE in hemodialysis patients with percutaneous coronary intervention: from the FU-Registry
Associations between lipid profiles and MACE in hemodialysis patients with percutaneous coronary intervention: from the FU-Registry
复制标题
经皮冠状动脉介入治疗的血液透析患者血脂谱与 MACE 之间的关联：来自 FU-Registry
DOI：
10.1016/j.jjcc.2014.03.016
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发表时间：
2015
期刊：
影响因子：
2.5
通讯作者：
Saku K
中科院分区：
文献类型：
--
作者：
Nagata I;Ike A;Nishikawa H;Zhang B;Sugihara M;Mori K;Iwata A;Kawamura A;Shirai K;Uehara Y;Ogawa M;Miura S;Saku K
背景众所周知，血液透析（HD）患者的经皮冠状动脉介入治疗（PCI）与支架内再狭窄和主要不良心血管事件（MACE）的发生率高于非HD患者，即使达到了胆固醇管理的目标值。我们选择了142名HD患者，（164处病变），无急性冠脉综合征（ACS），来自2148例患者（2568处病变）接受PCI的患者[UMIN 000005679，福冈大学医院EC/IRB：10-1-08（09-105）]，并比较了52例患者90例患者（53处病变）发生MACE [MACE（+）]（111处病变）无MACE [MACE（−）]。（TC：150 ± 30 mg/dL vs 166 ± 39 mg/dL，p< 0.05）和高密度脂蛋白胆固醇随访时，MACE（+）组的HDL-C水平（40.1 ± 14.7 mg/dL vs 47.8 ± 13.5 mg/dL，p< 0.01）显著较低。PCI前后其他参数无显著差异，包括甘油三酯、低密度脂蛋白胆固醇（LDL-C; LDL-C/HDL-C比值，以及HDL-C、非HDL-C、LDL-C的%变化）和血红蛋白A1 c（美国国家糖化血红蛋白标准化计划）。PCI时的TC、LDL-C和非HDL-C以及9个月随访时的TC和HDL-C与MACE呈负相关，而体重指数（BMI）[比值比（OR）：0.81; 95%置信区间（CI）：0.68-0.95]、既往冠状动脉旁路移植术（CABG）（OR：3.89; 95%CI：1.29-12.6），胰岛素使用（OR：3.17; 95%CI：1.23-8.55）与多因素分析中的MACE强相关。结论BMI、CABG和胰岛素使用是HD患者MACE的独立预测因子，但不是LDL-C，这表明在PCI时将非HD患者的脂质管理应用于HD患者可能不一定有利于中期临床结局。
BackgroundIt is well known that percutaneous coronary intervention (PCI) in hemodialysis (HD) patients is associated with higher rates of in-stent restenosis and major adverse cardiovascular events (MACE) compared to that in non-HD patients, even if the target value in cholesterol management is achieved.MethodsTo evaluate the factors that are associated with MACE in HD patients, we selected 142 HD patients (164 lesions) without acute coronary syndrome (ACS) from 2148 patients (2568 lesions) who underwent PCI in our database of the FU-Registry [UMIN000005679, Fukuoka University Hospital EC/IRB:10-1-08(09-105)], and compared 52 patients (53 lesions) with MACE [MACE(+)] to 90 patients (111 lesions) without MACE [MACE(−)].ResultsTotal cholesterol (TC: 150 ± 30 mg/dL vs 166 ± 39 mg/dL,p< 0.05) and high-density lipoprotein cholesterol (HDL-C: 40.1 ± 14.7 mg/dL vs 47.8 ± 13.5 mg/dL,p< 0.01) levels were significantly lower in the MACE(+) group at follow-up. No significant differences were observed in other parameters, including triglyceride, low-density lipoprotein cholesterol (LDL-C; LDL-C/HDL-C ratio, and % changes in HDL-C, non-HDL-C, LDL-C), and hemoglobin A1c (US National Glycohemoglobin Standardization Program) between before and after PCI. TC, LDL-C, and non-HDL-C at the time of PCI and TC, and HDL-C at the 9-month follow-up were negatively correlated with MACE, while body mass index (BMI) [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.68–0.95)], prior coronary artery bypass graft (CABG) (OR: 3.89; 95%CI: 1.29–12.6), and insulin use (OR: 3.17; 95%CI: 1.23–8.55) were strongly correlated with MACE in a multivariate analysis.ConclusionBMI, CABG, and insulin use, but not LDL-C, are independent predictors of MACE in HD patients, suggesting that the application of lipid management for non-HD patients to HD patients at the time of PCI may not necessarily be beneficial for medium-term clinical outcomes.