The Research Of Correlation Between Serum Lipid Level And The Progress Of Non-culprit Coronary Lesions In Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Objective:Retrospective analyze coronary heart disease(CHD)patients whose coronary angiography(coronary angiography,CAG)show the original stent is smooth while non-culprit coronary lesions(NCCLs)progresses after PCI(percutaneous coronary intervention(PCI))for 6 months or more,to study the effects of blood lipid parameters and other related factors on the progression of NCCLs.Exploring the high risk factors of the NCCLs progression to prevent the progression of the NCCLs after PCI,and provide a theoretical basis for the treatment of PCI and improve the prognosis of these patients.Methods:Tolal of 97 CHD patients whose CAG shows the original stent is smooth after PCI for 6 months or more from the Second Clinical Hospital of Shanxi Medical University during January 2011 to June 2015 were enrolled.All patients were divided into NCCLs disease progression group(n = 42)and non-progression group(n = 55)based on the results of CAGs and NCCLs lesions.Patient data including general information,case history,blood lipid level,coronary lesion,stent count and statin use status were entered into the computer database.SPSS17.0 and MedCalc were used to data analysis,univariate analysis was used to study the difference of the relevant factors in the two groups,binary logistic regression was used to assess the effects of various factors on the progression of NCCLs.ROC curve,sensitivity and specificity were used to evaluate of the progress of NCCLs.Results:1.General information: 97 patients meet the inclusion criteria and exclusion criteria were enrolled in our study,all patients received drug-coated stent(DES)implantation and reexamine CAG after PCI for more than 6 months.The average age was 59.98 ± 8.74 years old,including 80 males(81.6%),mean age 59.58 ± 8.93 years,17 females(17.3%),mean age 61.88 ± 7.72 years.According to the diagnostic criteria and related medical history,41 cases(42.3%)of smokers,61 cases(62.9%)with hypertension,23 patients with diabetes(23.7%),41 patients with hyperlipidemia(42.3%),and 20 cases of family history of CHD(20.6%).According to the results of the second CAG,patients were divided into NCCLs disease progression group and non-progression group.Among them,55 cases(56.7%)in non-progress group,42 cases(43.3%)in the progress group,and 22 cases of(52.8%)the progress group needed revascularization.The statins used in these patients are mostly atorvastatin and rosuvastatin,average dose were 13.82 ± 4.90 mg / d and 6.91 ± 2.45 mg / d respectively.The compliance rates of LDL-C and non-HDL-C in progress group and non-progress group were 50.9%,26.2% and 52.7%,40.5%,respectively.2.Univariate analysis: Age,smoking,hypertension,diabetes,hyperlipidemia and family history have no statistically significant difference between the two groups(P>0.05).There was significant difference in sex,total cholesterol(TC),LDL-C,non-HDL-C and lipoprotein a(Lp(a))in the two groups(P<0.05).No significant difference was discovered in the number of coronary lesions,the number of implanted DES stents and the remaining serological indexes in the primary coronary angiography in the two groups(P>0.05).3.Logistic Multivariate Regression Analysis of NCCLs Progression: Further analysis of gender,TC,LDL-C,non-HDL-C and Lp(a)by Logistic multivariate regression analysis shows gender,TC was not statistically significant different between the two groups(P> 0.05).While LDL-C(OR=1.150,95% CI: 1.033 ~ 23.669),non-HDL-C(OR=7.856,95% CI: 1.049 ~ 58.853)and Lp(a)(OR=1.974,95% CI: 1.950 ~ 12.999)were statistically different between the two groups(P <0.05).4.Predictive value of serum lipid-related markers in diagnosis of NCCLS progression: ROC curves were plotted on LDL-C,non-HDL-C,Lp(a)and combined predictors of NCCLs,and result showed that all of them have diagnosis value for NCCLs progression.Compared the area under the curve to analyze whether they have different efficacy on the diagnosis of NCCLs disease progression,and result showed that there was no significant difference between non-HDL-C and Lp(a),LDL-C and combined predictors(P> 0.05),while there was significant difference between non-HDL-C and LDL-C,LDL-C and Lp(a),Lp(a)and co-predictor,non-HDL-C and co-predictor(P<0.05).Conclusion:1.In lipid parameters,LDL-C,non-HDL-C and Lp(a)levels can be used as an independent risk factor for predicting the progression of NCCLs in CHD patients after PCI.2.The statins used in patients with CHD after PCI were mostly statins such as atorvastatin and rosuvastatin,but the daily dose was low.LDL-C and non-HDL-C compliance rate in either progress group or non-progress group is low,it is need for further improve.3.CHD patients with LDL-C in the state of standard,NCCLs progression still possibly occurred,suggesting that CHD is a multi-factor disease,strict control of other factors other than blood lipid is also important;on the other hand,further strengthen to reduce the intensity LDL-C may be required.4.Single factor maybe different to correctly judgment the progression of NCCLs,united analysis of LDL-C?Lp(a)and non-HDL-C may have a better value for predicting and judging the progression of NCCLs in patients with CHD after PCI.