Predictive Value Of Apolipoprotein A-Ⅰ On Long-term Clinical Outcomes After Interventions For Patients With Coronary Artery Disease

Objective: Apolipoprotein AⅠ(APOAⅠ)levels are associated with the incidence of coronary atherosclerotic heart disease(CAD),but whether APOAⅠ levels are relevant to the clinical outcomes of CAD patients undergoing percutaneous coronary intervention(PCI)has not been studied.Methods:From December 2016 to October 2021,this study comprised 15,250 PCI-treated CAD patients at the First Affiliated Hospital of Xinjiang Medical University.These individuals were sorted into three groups as per the tertile of APOAⅠ levels: first tertile(APOAⅠ ≤ 1.03 g/L,n = 4707),second tertile(1.03 g/L <APOAⅠ ≤ 1.22 g/L,n = 4657),and third tertile(1.22 g/L < APOAⅠ,n = 4913).24 months was the median duration of follow-up.All-cause mortality(ACM)and cardiac mortality comprise the primary outcome.Major adverse cardiovascular events(MACEs)and major adverse cardiovascular and cerebrovascular events(MACCEs)were the secondary endpoints.Multivariate Cox regression models were utilized to evaluate the APOAⅠ’s predictive power for outcomes.Results: Among the overall population,there were significant distinctions across the three groups with regard to the incidences of ACM,CM,MACEs,and MACCEs(all p<0.001).According to multivariate Cox regression analysis,APOAⅠ was a significant predictor of ACM(hazard ratio [HR]:2.762 [95% confidence interval [CI]: 1.828-4.174],P < 0.001),CM(HR:2.736,95% CI:1.704-4.393,P < 0.001),and MACEs(HR:1.309,95% CI:1.027-1.670,P = 0.030)in the acute coronary syndrome(ACS)patients.However,it was a significant predictor of ACM occurrence independently of other factors(HR:2.817,95%CI:1.534-5.174,P<0.001),CM(HR=3.302,95%CI:1.538-7.087,P=0.002)in chronic coronary syndrome(CCS)patients.The inflection point of this curve for APOAⅠ was 1.2g/L.When APOAⅠ< 1.2g/L,decreased APOAⅠ was significantly associated with increased risk of ACM,CM,MACEs,and MACCEs.The risk of ACM,CM,MACEs,and MACCEs was the lowest at 1.2g/L,whereas no remarkable change in risk was observed at >1.2 g/L.When APOAⅠ>1.2g/L,the increased risk of MACEs and MACCEs was no statistical significance.Conclusion: APOAⅠ has a predictive value for long-term clinical outcomes in CAD patients,and may be a new target for pharmacological intervention.