Background and Objective: Percutaneous coronary intervention(PCI)is one of the important means for the treatment of coronary heart disease,in the clinical practice,quite a few patients still need revascularization after PCI due to the progression of target and non-target diseased vessels.The early clinical studies have shown that the residual lipoprotein cholesterol(RLP-C)has the effect to atherosclerosis,which is associated with an increased risk of cardiovascular disease.Studies have shown that plasma residual cholesterol in patients with type 2 diabetes is higher than that in non-diabetic patients,and that the former associated with increased revascularization after PCI.At present,there are few studies on the correlation between residual cholesterol and non-target vessel progression in patients with type 2diabetes after PCI,and the relationship between the two remains unclear.Therefore,this study aims to preliminarily investigate the correlation between RLP-C and non-target vessel progression in type 2 diabetes patients after PCI.Methods: In this study,193 patients with coronary heart disease combined with type 2 diabetes who underwent initial PCI and angiographic follow-up in the Department of Cardiology,the First Hospital of Lanzhou University from January 1,2018 to December 31,2020 were retrospectively enrolled.Patients’ basic information,past medical history,personal history,medication history,laboratory test indicators,ejection fraction of ultrasonic cardiogram and the results of the coronary angiography were collected from the medical record system.The enrolled patients were divided into non-target vessel progression group and non-progression group according to the second coronary angiographic findings.The difference of baseline data between the two groups was compared,single factor analysis and multivariate analysis were conducted to study the risk factors of non-target vessel progression in type 2 diabetes patients.The patients were divided into two groups based on whether the laboratory indices were tested in fasting blood serum,to explore the correlation between fasting RLP-C,non-fasting RLP-C and non-target vessel progression in type 2 diabetes patients.Subgroup analyses were conducted according to whether LDL-C and non-HDL-C reached the standard(non-HDL-C reached the standard: <2.0mmol/L,LDL-C reached the standard: <1.4mmol/L),to explore the correlation between RLP-C and the progression of non-target vessel lesions under the condition of reaching or not reaching the standard of LDL-C and non-HDL-C,and to draw the ROC curve to evaluate the predictive value of residual cholesterol and non-HDL-C on the progression of non-target vessels.Results: 1.Baseline data analysis: A total of 193 patients were enrolled in this study,101 patients in the non-progressive group and 92 patients in the progressive group.Age,BMI,hypertension,blood glucose,the number of coronary diseased vessel ≥3 branches and angiographic follow-up time in the progressive group were higher than those in the non-progressive group,with no significant differences(P>0.05).The Smoking,Hb A1 c and insulin treatment in the progressive group were higher than those in the non-progressive group,with the significant differences(P<0.05).2.TC,TG,non-HDL-C,LDL-C and RLP-C in the progressive group were higher than those in the non-progressive group,but only RLP-C had significant difference(P<0.05);the HDL-C in the progressive group was lower than that in the non-progressive group,with no significant differences(P>0.05).3.Univariate and multivariate logistic regression analysis was used to explore the risk factors of non-target vessel progression.The results showed that smoking,non-HDL-C,RLP-C and insulin therapy had significant effects on non-target vessel progression in univariate analysis.Smoking,RLP-C,insulin treatment,the number of coronary diseased vessel ≥3 branches and angiographic follow-up time were included in the regression model.The results showed that smoking and insulin treatment were independent risk factors for non-target vessel progression in type 2 diabetes after PCI.4.The patients were were divided into two groups based on whether the lipid were tested in fasting blood serum,92 cases of non-fasting and 101 cases of fasting.There was no significant correlation between non-fasting RLP-C and non-target vessel progression(P>0.05),while fasting RLP-C was positively correlated with non-target vessel progression(P<0.05).5.Subgroup analyses of patients with fasting blood lipid showed that RLP-C was in non-HDL-C<2.0mmol/L and LDL-C<1.4mmol/L group,non-HDL-C<2.0mmol/L and LDL-C≥1.4mmol/L group,non-HDL-C<2.0mmol/L and/or LDL-C<1.4mmol/L group,had no significant correlation with non-target vessel progression(P>0.05).In non-HDL-C>2.0mmol/L and LDL-C ≥ 1.4mmol/L group,there was a positive correlation between RLP-C and non-target vessel progression(P<0.05).The results of binary logistic regression analysis with coronary heart disease risk factors showed that RLP-C was a risk factor for non-target vessel progression.6.ROC curve analysis:The area under the ROC curve for predicting the progression of non-target vessels by RLP-C was 0.689(P=0.0198),the area under the ROC curve of non-HDL-C was 0.709(P=0.0083),and there was no significant difference in the ability to predict the progression of non-target vessels(P=0.7914).Conclusion: Fasting RLP-C is significantly associated with non-target vessel progression in patients with type 2 diabetes mellitus after PCI,while RLP-C is not a risk factor for non-target vessel progression when non-HDL-C is up to standard. |