| BackgroundArteriosclerotic cardiovascular disease(ASCVD)is now a leading cause of death in our country,and dyslipidemia has been identified as one of the most important atherogenic factors.Lp(a)is a plasma lipoprotein formed by apolipoprotein A linked to apolipoprotein B-100 by disulfide bonds.Plasma Lp(a)level is mostly genetic-mediated and heritably controlled by the autosomal-dominat inherited LPA gene located on chromosome 6q26-27,which means it's individualy variated and hardly influenced by age,gender,diet and other enviromental factors,and is mostly consistent in individuals,except in the presence of acute inflammation or stress such as acute myocardial infarctions or surgeries.Past researches revealed the atherogenic and thrombogenic effect of Lp(a)and its role in lipids metabolism,clotting and fibrinolytie system and the proliferation of smooth mviscle cells[1],yet its connection to the adverse outcomes after percutaneous coronary intervention like in-stent restenosis and the development of non-target coronary lesions remains largely unknown and contradictory,also,most of previous researches were conducted in patients with bare metal stents instead of drug-eluting stents.Methods1?Data Collection General clinical characteristics like age,sex,smoking history,cerebrovascular disease,hypertension,type 2 diabetes and time between two angiographies were collected from medical record system.Alanine transaminase(ALT),Aspartate transaminase(AST),seram creatinine(Scr)?high sensitivity C-reactive protein(hs-CRP),fasting blood glucose(FBS),glycosylated hemoglobin(HbAlc),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),apolipoprotein A-I(ApoA-I),apolipoprotein B-100(ApoB100),Lp(a)and so on.2?PCI All PCI pocedures were completed by experienced cardiac interventional physicians.Aspirin(100mg/d)combined with clopidogrel(75mg/d)or tigrilol(90mg/d)were taken twice/d)for at least 12 months after DES stenting.Based on patients'conditions,statins,angiotensin converting enzyme inhibitor(ACEI),angiotensin receptor antagonist(ARB)?p receptor blocker or calcium antagonist(CCB)were added by cardiovascular physicians.All patients underwent another selective coronary angiography within 1 to 4 years after PCI.The main coronary arteries included left main trunk,left anterior descending branch,left circumflex branch,right coronary artery and its branches.The severity of coronary artery stenosis was expressed as a percentage of the decrease in vessel diameter at the stenosis site.Stenosis over 50%of the internal diameter of the left main trunk,circumflex branch or right coronary artery or main branch was a target lesion and 100%complete occlusion.Based on the situations of vascular lesions,they can be divided into single-vessel,double-vessel and multi-vessel lesions.3?Diagnosis(1)Coronary artery disease:based on the Diagnostic Criteria of Coronary Atherosclerotic Heart Disease(WS319-2010),combined with the patients history,clinical manifestations,auxiliary examination and serum myocardial injury markers to diagnose coronary heart disease[2].All patients with coronary artery disease included in this study met the diagnostic criteria above and coronary angiography showed that the internal diameter of at least one main coronary artery or main branch of coronary artery with a 50%stenosis.(2)Smoking history:any of the following conditions were met:(1)Smoking at present,and the number of cigarettes was more than 5 per day;(2)The previous smoking time was more than 10 years;(3)At present,smoking had been quit,but less than 1 year.(3)Cerebrovascular disease:cerebral infarction or cerebral hemorrhage was diagnosed by cranial CT or MRI.(4)Hypertension:based on the Chinese Guidelines for the Prevention and Treatment of Hypertension(2018 revision),hypertension is defined as measuring systolic blood pressure(140mmHg)and/or diastolic blood pressure(90mmHg)without the usage antihypertensive drugs[3].Blood pressure in the consultation room should be measured by trained medical staff in accordance with the uniform standard under standard conditions.(5)Type 2 diabetes:Based on the guidelines for the Prevention and treatment of Type 2 Diabetes in China(2017 Edition),to be diagnosed as Type 2 diabetes,one shall meet any of the following criteria:1 typical diabetic symptoms(polyphagia,polyuria,polyphagia,unexplained weight loss)plus random blood glucose of 11.1 mmol/L;2 fasting blood glucose was 7 mmol/L,3 glucose tolerance test 2 h blood glucose/11.1 mmol/L[4],(5)In-stent restenosis:follow-.up coronary angiography after PCI showed in-stent and stent edge 5mm lumen loss>50%;(6)Non-target lesions:(1)Coronary artery lesions that existed during PCI but did not undergo interventional surgery(balloon angioplasty or stent implantation);(2)New lesions;(7)Minimum lumen diameter(MLD):coronary angiography showed the diameter of the narrowest vessel,(8)In-stent Late Lumen Loss(LLL):The minimum lumen diameter after stenting minus the minimum lumen diameter at follow-up.(9)Reference vessel diameter:the average diameter of 5mm in the proximal and distal segments of the diseased vessels;(10)In-stent restenosis rate=Number of patients with in-stent restenosis/Number of patients in a group × 100%;(11)Lp(a)grouping standard:Based on the Consensus of the European Atherosclerosis Society:?500mg/L was defined as high LP(a)and<500mg/L was defined as low Lp(a)[5].4?Follow up(1)Severity of coronary artery disease:coronary artery stenosis or chronic coronary artery occlusion was regarded as coronary artery stenosis,in which the number of diseased vessels with coronary stenosis was divided into single branch,double branch,three branches and left main artery and three vessels,while chronic coronary occlusion was divided into with or without coronary artery stenosis.(2)Location of coronary artery lesion:left trunk,anterior descending branch,circumflex branch,right coronary artery;(3)Number of stents:one,two,three or more stents;(4)Stent types:rapamycin and non-rapamycin stents;(5)Quantitative analysis of coronary artery(quantitativecoronaryangiography,QCA):minimum lumen diameter before stent and minimum lumen diameter after stent;(6)Follow-up coronary angiography observation indexes:the proportion of patients with coronary lesions in non-target vessels,the proportion of patients with non-target lesions,the rate of in?stent restenosis,in-stent late lumen loss.5?Data Analysis SPSS 20.0 was used in data analysis.When the distribution of quantitative data satisfies normality,it is described by±s;when it is skewed distribution,it i5 described by median;t test or rank sum test i5 used for comparison.The qualitative data were expressed in terms of rate(%),and chi-square test was used for comparison.Multivariate Logistic regression model was used to analyze the risk factors of in-stent restenosis and coronary non-target lesions.The difference wa statistically significant with P<0,05.Results1.In the comparison of the baseline data between the stenosis group and the non?restenosis group,there were sig1ificant differences in Lp(a)and the number of stents between the two groups.The Lp(a)in the restenosis group was significantly higher than that in the non-restenosis group(437.57±391.60 and 279.46±288.06,P<437.57),and the number of stents in the restenosis group was also significantly higher than that in the non-restenosis group(1.73±0.79/person vs 1.27±0.55/person,P<0.05).There was no significant difference in TG?LDL-C,HDL-C,ApoAl,ApoB,age,sex,smoking history,cerebrovascular disease,hypertension and type 2 diabetes mellitus,FBS3 Scr,hs-CRP and HbAlc between the two groups.2.Lp(a)was used to observe the severity of coronary artery lesions in 33 patients with high LP(a)(and 141 patients with low Lp(a).The proportion of three-vessel lesions in the high Lp(a)group was significantly higher(65.6%and 60.3%,P<0.05),and the proportion of left trunk plus three-vessel lesions was also higher(25.0%and 9.9%,P<0.05).3.The independent risk factors of in-stent restenosis were explored by multivariate Logistic regression analysis.The results showed that the number of stents implanted and the level of Lp(a)were significantly correlated with the occurrence of in-stent restenosis(OR=3.389;).OR=8.638,P<0.01),that is,the number of stents implanted and the level of Lp(a)were independent risk factors for in-stent restenosis in PCI patients with DES.4.Among the total population included,the patients were divided into two groups:high Lp(a)and low Lp(a).During follow-up,QCA showed that the proportion of patients with coronary lesions in non-target vessels,the proportion of patients with non-target lesions and the rate of in-stent restenosis in high Lp(a)group were significantly higher than those in low Lp(a)group(69.70%and 37.6%,P<0.05).87.9%and 41.6%,36.5%and 13.5%,P<0.05),and the minimum lumen diameter decreased significantly(1.90±0.69 and 1.54±0.73,P<0.05).The diameter of late coronary artery lumen loss was also larger(0.81±0.84 and 0,42±0.61,P<0.05).Multivariate Logistic regression analysis was used to explore the risk factors of non-target lesions in patients,and the level of Lp(a)was significantly correlated with the occurrence of non-target lesions(OR=8.638,P<0.01),prompting that the level of Lp(a)is an independent risk factor for the occurrence of in-stent non-target lesions in patients with PCI implanted DES.ConclusionElevated Lp(a)is an independent risk factor for both in-stent restenosis and the development non-target coronary lesions,and is closely related to the relapse and aggravation of coronary artery disease. |
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