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Clinical predictors for progression of nonintervened nonculprit coronary lesions despite low-density lipoprotein cholesterol less than 1.8 mmol/l after successful stent implantation.
MedLine Citation:
PMID:  21150778     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Despite achieving very low levels of low-density lipoprotein cholesterol (LDL-C), many patients continue to show disease progression. We sought to characterize the clinical factors that correlate with nonculprit lesion plaque progression in patients with LDL-C level less than 1.8 mmol/l. METHODS: Between May 2006 and December 2009, 653 patients met the following criteria: (i) underwent coronary angiograms again with a time interval from 6 months to 2 years after successful stent implantation, (ii) less than 50% stenoses of nonintervened nonculprit coronary lesions (NCLs), (iii) follow-up LDL-C levels less than 1.8 mmol/l. Patients were classified as progressors [NCL-percutaneous coronary intervention (PCI)] or nonprogressors (non-NCL-PCI). RESULTS: Five patients with de novo NCL and 87 patients with preexisting NCL developed progression. Progressors had higher percentage of acute coronary syndrome (ACS), multivessel diseases and triglycerides (TGs) at baseline PCI. At follow-up, a significant difference was observed between progressors and nonprogressors in TG (1.73 vs. 1.32 mmol/l, P<0.001), change in TG (-0.18±1.01 vs. -0.42±1.02 mmol/l, P=0.032), high-density lipoprotein cholesterol (HDL-C) (0.98±0.22 vs. 1.08±0.25 mmol/l, P=0.001) and change in HDL-C (0.11±0.17 vs. 0.19±0.27 mmol/l, P<0.001). Multivariate logistic regression analysis revealed that ACS, multivessel diseases, on-treatment TG and HDL-C and smaller increases in HDL-C were independent predictors for progression. CONCLUSION: Despite attainment of LDL-C level less than 1.8 mmol/l, NCL had still progressed, mainly in preexisting NCL rather than de novo NCL. ACS, multivessel diseases, on-treatment TG, HDL-C and smaller increases in HDL-C were associated with the NCL progression. This finding highlights the need for intensive modification of global risk in patients with coronary artery disease.
Zhao-Xia Yin; Yu-Jie Zhou; Xiao-Li Liu; Hong-Ya Han; Shi-Wei Yang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-10
Journal Detail:
Title:  Coronary artery disease     Volume:  -     ISSN:  1473-5830     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aDepartment of Cardiology, Fuxing Hospital bDepartment of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China.
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