White Blood Cell Counts to High-Density Lipoprotein Cholesterol Ratio, as a Novel Predictor of Long-Term Adverse Outcomes in Patients After Percutaneous Coronary Intervention: A Retrospective Cohort Study.
White Blood Cell Counts to High-Density Lipoprotein Cholesterol Ratio, as a Novel Predictor of Long-Term Adverse Outcomes in Patients After Percutaneous Coronary Intervention: A Retrospective Cohort Study.
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白细胞计数与高密度脂蛋白胆固醇比率，作为经皮冠状动脉介入治疗后患者长期不良结果的新预测因子：一项回顾性队列研究
DOI：
10.3389/fcvm.2021.616896
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发表时间：
2021
影响因子：
3.6
通讯作者：
Xie X
中科院分区：
文献类型：
--
作者：
Wu TT;Zheng YY;Xiu WJ;Wang WR;Xun YL;Ma YY;Kadir P;Pan Y;Ma YT;Xie X
背景：白细胞（WBC）计数和高密度脂蛋白胆固醇（HDL - C）在临床实践中广泛应用。然而，其对心血管疾病（CVD）的预测价值尚不明确。在本研究中，我们首先评估了白细胞与高密度脂蛋白胆固醇比值（WHR）在接受经皮冠状动脉介入治疗（PCI）的冠状动脉疾病（CAD）患者中的预后价值。
方法：最初对一项回顾性队列研究（标识符：ChiCTR - INR - 16010153）中的6050例PCI术后CAD患者进行评估。由于HDL胆固醇数据缺失、恶性肿瘤、痴呆、银屑病或湿疹、系统性结缔组织疾病、多发性硬化症、慢性肝病以及慢性阻塞性肺疾病，371例患者被排除。最终，5679例患者纳入研究。主要结局是长期死亡率。次要终点主要是主要不良心脑血管事件（MACCEs），定义为卒中、心脏性死亡、支架内血栓形成、再发心肌梗死以及靶血管血运重建的组合。本研究的平均随访时间为35.9±22.5个月。我们根据受试者工作特征曲线（ROC）确定WHR的最佳截断值，然后根据该截断值将患者分为高WHR组和低WHR组。我们分别在急性冠状动脉综合征组（ACS）和稳定型CAD亚组中分析数据。
结果：总体而言，随访期间有293例长期死亡病例。根据截断值（WHR = 8.25），1901例ACS患者被分为高WHR组（n = 724）和低WHR组（n = 1177）。与低WHR组相比，高WHR组的全因死亡率（ACM，5.5%对3.6%，p = 0.048）和心脏性死亡率（4.7%对2.9%，p = 0.042）显著更高。在稳定型CAD组中，我们也发现高WHR组的ACM和心脏性死亡率显著高于低WHR组。我们未发现高WHR组和低WHR组在MACCEs发生率方面存在显著差异。多变量Cox比例风险模型显示，WHR水平升高与死亡率独立相关。在高WHR组中，ACS患者的ACM风险增加两倍[调整后风险比 = 2.036（1.258 - 3.296），p = 0.004]，稳定型CAD患者增加1.5倍[调整后风险比 = 1.586（1.178 - 2.136），p = 0.002]。
结论：本研究表明，白细胞计数与高密度脂蛋白胆固醇比值升高与接受PCI的CAD患者的长期死亡率独立相关。
Background: White blood cell (WBC) counts and high-density lipoprotein cholesterol (HDL-C) are widely available in clinical practice. However, the predictive value for cardiovascular disease (CVD) is uncertain. In the present study, we firstly assessed the prognostic value of WBC to HDL-C ratio (WHR) in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). Methods: Six thousand and fifty patients with CAD after PCI from a retrospective cohort study (identifier: ChiCTR-INR-16010153) were evaluated initially. Three hundred and seventy-one patients were excluded due to HDL cholesterol data not available, malignancy, dementia, psoriasis or eczema, systemic connective tissue disorders, multiple sclerosis, chronic liver disease, and chronic obstructive pulmonary disorder. Finally, 5,679 patients were included in the study. The primary outcome was long-term mortality. Secondary endpoints were mainly major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a combination of stroke, cardiac death, stent thrombosis, recurrent myocardial infarction, and target vessel revascularization. The mean follow-up time of this study was 35.9 ± 22.5 months. We defined the best cutoff value of MHR according to the receiver operating curve (ROC), and then patients were divided into high and low WHR groups according to the cutoff value. We analyzed the data in both an acute coronary syndrome group (ACS) and a stable CAD subgroup, respectively. Results: Overall, there were 293 cases of long-term mortality during the follow-up period. According to the cutoff value (WHR = 8.25), 1,901 ACS patients were divided into high WHR group (n = 724) and low WHR group (n = 1,177). Compared to low WHR group, the incidence of all-cause mortality (ACM, 5.5 vs. 3.6%, p = 0.048) and cardiac death (4.7vs. 2.9%, p = 0.042) were significantly higher in the high WHR group. In stable CAD group, we also found the incidence of ACM and cardiac death were significantly higher in the high group compared to that in the low group. We did not find significant difference between the high and the low WHR group in the incidence of MACCEs. The multivariate Cox proportional hazards model showed that increased WHR level was independently correlated with the mortality. In the high WHR group, the risk of ACM increased two times in ACS [adjusted HR = 2.036 (1.258–3.296), p = 0.004] and 1.5 times in stable CAD [adjusted HR = 1.586 (1.178–2.136), p = 0.002]. Conclusion: The present study indicated that an increased WBC count to HDL-C ratio was independently associated with long-term mortality in CAD patients who underwent PCI.