Objective: To analyze the association between plasma high-density lipoprotein cholesterol (HDL-C) levels and the severity of coronary artery disease, and to evaluate the impact of HDL-C levels on long-term outcomes in patients underwent percutaneous coronary intervention (PCI). Methods: A total of 10 458 consecutive patients underwent PCI from January 2013 to December 2013 at Fuwai hospital were enrolled in this study. Patients were divided into three groups according to HDL-C tertiles: low HDL-C group (HDL-C≤0.89 mmol/L, n=3 525), median HDL-C group (HDL-C>0.89-1.11 mmol/L, n=3 570) and high HDL-C group (HDL-C>1.11 mmol/L, n=3 363). SYNTAX score was used to evaluate the severity of coronary artery disease, linear regression was used to analyze the relationship of HDL-C and SYNTAX score. Kaplan-Meier survival analysis was used to compare the outcomes among the three groups. Multivariate Cox regression was used to define the potential associations of HDL-C and outcomes. Results: The HDL-C level was (1.03±0.28) mmol/L and the SYNTAX score was 11.7±8.1. Patients were older, proportion of female, stable angina pectoris, successful PCI and left ventricular eject fraction value were higher, while incidence of diabetes mellitus was lower, hyperlipidemia, old myocardial infraction, smoking history and left main and three vessels disease were lower in high HDL-C group (all P<0.05). Patients in high HDL-C group also had the lowest SYNTAX score (12.2±8.4 vs. 11.7±8.1 vs. 11.2±7.8, P<0.001). Both univariate and multivariate linear regression analysis showed that HDL-C was negatively associated with SYNTAX score, e.g. Univariate analysis: β=-0.046, P<0.001; Multivariate analysis: β=-0.058, P=0.001. And 10 400 (99.4%) patients completed 2-year follow up. At 2-year follow-up, there were no difference in all-cause death, cardiac death, myocardial infarction, revascularization, stroke, major adverse cardiovascular and cerebral events (MACCE) and stent thrombosis among three groups (P for trend>0.05), while patient in high HDL-C group experienced the highest BARC type 2 bleeding events (P for trend=0.018). Multivariate Cox regression analysis showed that HDL-C level was not an independent risk factor of 2-year adverse ischemia events (P>0.05) and 2-year bleeding events (P>0.05). Conclusion: In patients underwent PCI, plasma HDL-C level is negatively associated with SYNTAX score, but not an independent risk factor of ischemic and bleeding events post PCI.
目的： 探讨冠心病患者高密度脂蛋白胆固醇（HDL-C）水平与冠状动脉病变严重程度以及对经皮冠状动脉介入治疗（PCI）预后的影响。 方法： 连续纳入2013年1至12月在阜外医院行PCI治疗的10 458例患者，根据HDL-C水平分为3组：低三分位组（HDL-C≤0.89 mmol/L，3 525例）、中三分位组（HDL-C>0.89~1.11 mmol/L，3 570例）和高三分位组（HDL-C>1.11 mmol/L，3 363例）。采用线性回归分析HDL-C水平与冠状动脉病变严重程度（SYNTAX积分）的关系。使用Kaplan-Meier生存分析比较3组间的预后差别。同时采用多因素Cox回归分析HDL-C水平对预后的影响。 结果： 总体人群平均HDL-C水平为（1.03±0.28）mmol/L，平均SYNTAX积分为（11.7±8.1）分。HDL-C高三分位组患者年龄更大、男性更少、左心室射血分数更高，LDL-C水平更高，更少合并糖尿病、高脂血症、陈旧心肌梗死及吸烟史，稳定性心绞痛患者更多，左主干及三支病变比例更少，介入治疗成功率更高（P均<0.05）。HDL-C高三分位组SYNTAX积分更低[低、中、高三分位组分别为（12.2±8.4）、（11.7±8.1）和（11.2±7.8）分，P<0.001]。单因素及多因素线性回归分析均显示，HDL-C水平与SYNTAX积分呈负相关（单因素：β=-0.046，P<0.001；多因素：β=-0.058，P=0.001）。10 400（99.4%）例患者完成了2年随访，3组在全因死亡、心原性死亡、心肌梗死、卒中、血运重建、主要心脑血管不良事件以及支架内血栓发生率差异均无统计学意义（趋势检验P均>0.05）。高三分位组BARC 2型以上出血事件发生率更高（趋势检验P=0.018）。Kaplan-Meier生存分析显示，3组间全因死亡、心原性死亡、心肌梗死、卒中、血运重建、主要心脑血管不良事件及支架内血栓发生率差异均无统计学意义（P均>0.05），而高三分位组BARC 2型以上出血风险更高（P=0.017）。多因素Cox回归分析发现HDL-C水平不是2年全因死亡等缺血事件及出血事件的独立危险因素（P>0.05）。 结论： 冠心病行PCI治疗的患者，HDL-C水平与SYNTAX积分呈负相关，但HDL-C不是PCI患者缺血及出血事件的独立危险因素。.
Keywords: Coronary disease; High-density lipoprotein cholesterol; Percutaneous coronary intervention; Prognosis.