Study On The Correlation Between Visit-to-visit Lipid Variability And Cardiovascular Events In Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Objective: To investigate the correlation between visit-to-visit lipid variability and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention(PCI).Methods: A total of 250 patients who were admitted to the department of cardiovascular medicine of Hebei General Hospital from September 2017 to December 2018 were enrolled in this study.They were diagnosed with acute coronary syndrome and treated with PCI during hospitalization.Basic clinical data were collected at the time of admission.Lipid levels and the occurrence of major adverse cardiovascular events including recurrent angina,recurrent myocardial infarction,heart failure,and cardiogenic death were regularly collected in outpatient follow-up patients.Baseline measurements were defined as lipid levels at follow-up 1 month after discharge.A total of 228 patients with two or more post-baseline measurements were included in the final analysis.Visit-to-visit lipid variability was reflected by calculating the variability index including standard deviation(SD)and coefficient of variation(CV).Patients were divided into two groups(MACE group and non-MACE group)according to whether they had major adverse cardiovascular events(MACE).SPSS 21.0 statistical software was used for data processing,and P < 0.05 indicated that the difference was statistically significant.Results:1.Comparison of clinical data: There were statistical differences in age,previous PCI history,Hemoglobin(Hb)between the two groups(P < 0.05).There were no significant differences in gender,body mass index(BMI),smoking history,previous history of myocardial infarction,family history of cardiovascular disease,hypertension,diabetes,stroke,unstable angina pectoris,ST-segment elevation myocardial infarction,non-ST-segment elevation myocardial infarction,number of diseased blood vessels,indexes(fasting plasma glucose,creatinine,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglycerides),discharge medication(angiotensin converting enzyme inhibitor/Angiotensin receptor blocker,beta-blockers,calcium channel blocker,statins)between the two groups.(P > 0.05).2.Comparison of lipid variability between the two groups: The SD of LDL-C in MACE group was significantly higher than that in non-MACE group(0.420±0.201 vs.0.340±0.134,P < 0.001).The CV of LDL-C in MACE group was also significantly higher than non-MACE group(0.205±0.076 vs.0.161±0.049,P < 0.001).The SD of HDL-C in MACE group was significantly higher than that in non-MACE group(0.095±0.047 vs.0.079±0.030,P=0.003).The CV of HDL-C in MACE group was also significantly higher than non-MACE group(0.085±0.030 vs.0.076 ±0.016,P=0.004).There was no statistical difference in mean follow-up levels of HDL-C and LDL-C between the two groups.3.In the Kaplan-Meier survival analysis of LDL-C and HDL variability parameters,the highest quartile array(Q4)had a higher cumulative risk of morbidity than the lower quartile array(Q1-Q3).4.In the multivariate COX regression analysis of short-term cardiovascular prognosis,previous PCI history(HR=2.718,95%CI: 1.193-2.578,P=0.042),SD of LDL-C(HR=1.128,95%CI: 1.099-1.334,P=0.001),CV of LDL-C(HR=1.161,95%CI: 1.087-1.258,P=0.001),SD of HDL-C(HR=1.352,95%CI: 1.142-1.615,P=0.001),CV of HDL-C(HR=1.364,95%CI: 1.171-1.582,P=0.001)were independent risk factors for MACE.Conclusions:Visit-to-visit variability in LDL-C and HDL-C,history of PCI were independent predictors of short-term cardiovascular events in ACS patients after PCI.