Zhongguo quanke yixue (Jan 2025)
Association of Residual Cholesterol with Vulnerable Plaques in Non-culprit Lesions Progressing to Major Adverse Cardiovascular Events
Abstract
Background Remnant cholesterol (RC) is considered a significant risk factor for atherosclerotic cardiovascular diseases, and the progression of non-culprit coronary lesions (NCCLs) is also a prominent issue affecting the prognosis of patients with coronary artery disease. However, the relationship between residual cholesterol and vulnerable plaques in NCCLs that progress to major adverse cardiovascular events (MACE) is not well understood. Objective To explore the predictive value of RC for vulnerable plaques in NCCLs that develop MACE and its correlation with long-term prognosis. Methods A total of 488 patients with coronary artery disease admitted to the Cardiac Center of the First Affiliated Hospital of Xinjiang Medical University from February 2015 to February 2022 were selected as the study subjects. Baseline data of the patients were collected through the electronic medical record system, and coronary angiography and optical coherence tomography (OCT) were performed. Enrolled patients received scheduled follow-up at 1, 3, 6, and 12 months after discharge. Spearman's rank correlation test was used to explore the correlation between RC and the characteristics of thin-cap fibroatheroma (TCFA) plaques in NCCLs. Multiple Logistic regression analysis was used to explore the influencing factors of MACE in TCFA of NCCLs. The receiver operating characteristic curve (ROC curve) was plotted, and the area under the ROC curve (AUC) was calculated to explore the predictive value of RC for MACE in TCFA of NCCLs. Results A total of 488 coronary artery disease patients were included, and patients were divided into MACE group (n=38) and non-MACE group (n=450) based on whether NCCLs developed MACE. Plaque characteristics of NCCLs were identified by OCT, and a total of 749 NCCL plaques were analyzed, with 304 NCCL plaques having a minimum lumen area (MLA) <3.5 mm2. During the follow-up period, 38 patients (7.8%) experienced 41 MACE events caused by NCCL plaques, 18 patients (3.7%) developed in-stent restenosis, and 15 patients (3.1%) had deaths due to uncertain factors. The proportion of patients with hypertension, diabetes, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), RC, glycated hemoglobin (HbA1c), TCFA, and MLA <3.5 mm2 in the MACE group was higher than that in the non-MACE group (P<0.05). TCFA was detected in 105 patients, of which 22 cases developed MACE (TCFA MACE group), and 83 cases did not develop MACE (non-TCFA MACE group). The proportion of diabetes and RC in the TCFA MACE group was higher than that in the non-TCFA MACE group (P<0.05). The results of Spearman's rank correlation analysis showed that RC was negatively correlated with the thinnest fibrous cap thickness and MLA (rs=-0.665、-0.771, P<0.05), and positively correlated with the maximum lipid arc and macrophage infiltration (rs=0.806、0.481, P<0.05). The results of Multiple Logistic regression analysis showed that diabetes (OR=3.410, 95%CI=1.165~9.988, P=0.025) and high level of RC (OR=5.879, 95%CI=1.436-24.073, P=0.014) was a risk factor for MACE in TCFA of NCCLs. The ROC curve for predicting MACE in TCFA of NCCLs by RC showed an AUC of 0.695 (95%CI=0.571-0.819, P=0.005), with the optimal cutoff value of 0.606 mmol/L, and sensitivity and specificity of 0.818 and 0.518, respectively. Conclusion Elevated levels of RC may be a risk factor for the development of MACE in vulnerable plaques of NCCLs in patients with coronary artery disease, and it has certain predictive value for MACE in TCFA of NCCLs.
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