Prognostic Value Of Non-High-density Lipoprotein Cholesterol On Major Adverse Cardiovascular Events In Patients With Coronary Heart Disease Undergoing Percutaneous Coronary Intervention

Objective:To investigate the prognostic value of non-high-density lipoprotein cholesterol on major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).Methods:This study enrolled 272 participations diagnosed with CHD and underwent PCI from March 2013 to May 2014 in the first affiliated hospital of Fujian Medical University.Non-HDL-C was obtained by subtracting HDL-C from total cholesterol.According to the preoperative Non-HDL-C level,patients were divided into 3 groups:G1(n=65,Non-HDL-C<2.6 mmol/L),G2(n=82,Non-HDL-C 2.6~3.4mmol/L)and G3(n=125,Non-HDL-C>3.4 mmol/L).All patients were followed up in a median period of 36 months,major adverse cardiovascular events included all-cause mortality,non-fatal myocardial infarction,non-fatal stroke,recurrent angina and revascularization treatment.The correlation between Non-HDL-C and incidence rates of MACE was analyzed by Cox proportional hazard model and Kaplan-Meier plot.All statistical analysis were conducted using SPSS version 22.0 and P-values less than 0.05 was considered statistically significant.Results:(1)Aspirin、clopidogrel、statin、β receptor blocker、ACEI/ARB were respectively prescribed to 98.53%、91.18%、97.43%、72.05%、47.79% of patients when discharged after PCI.The usage rate of aspirin 、 clopidogrel significantly decreased to 81.19%、21.78%(P<0.001)after 31 months’ follow-up,while no significant change was found in other three drugs’ usage.(2)The level of TC,TG and LDL-C increased with elevation of Non-HDL-C(P<0.001),patients with myocardial infarction at baseline in G3 was significantly higher than that in G1 and G2(P<0.05).(3)A total of 60 major adverse cardiovascular events occurred during the follow-up,the baseline level of Non-HDL-C of patients with MACE was higher than those without MACE(3.86±1.24 vs 3.28±1.03mmol/L,p<0.001).(4)The incidence rates of total MACE and recurrent angina in G3 significantly rose in comparison with G1(28.80% vs 12.31%,15.20% vs 3.08%,P<0.05).However,no difference was found between G3 and G2.(5)Cox multi-factor regression analysis found that age and Non-HDL-C level were independent risk factors for MACE,the adjusted ORs to predicting MACE risk in patients with CHD after PCI were 1.495(95%CI:1.217-1.836,P<0.001)for Non-HDL-C,1.026(95%CI:1.000-1.053,P=0.049)for age.(6)Lipid levels were tested among 142 patients when followed up for at least one year,the control rate of Non-HDL-C and LDL-C significantly improved(P<0.05).Compared with patients with substandard Non-HDL-C or LDL-C levels at baseline,those reached control standard when followed up for at least one year had a downward but not significant trend of incidence rates of MACE(22.00% vs 17.54%,18.52% vs 12.5%,P>0.05).Conclusion:The baseline level of Non-HDL-C had a significant predictability as a risk marker on MACE after PCI,Non-HDL-C level played as a certain target for lipid management in secondary prevention of CHD.