Abstract 283: Variation In Ticagrelor Utilization And Outcomes In Patients With Acute Coronary Syndrome

Background: Ticagrelor is a P2Y12 inhibitor with better cardiovascular outcomes than clopidogrel in clinical trials for acute coronary syndromes. However, the adoption of ticagrelor into clinical practice has been understudied. Therefore, we evaluated: 1) temporal trends in ticagrelor use, 2) factors associated with its use, and 3) hospital variation in its adoption and clinical outcomes. Methods: We conducted a population-based cohort study using administrative claims data in Ontario, Canada between 4/2014 and 3/2018. We identified individuals >65 years of age who were admitted for myocardial infarction (MI) or unstable angina (UA) and filled a prescription for ticagrelor or clopidogrel at or within 7 days of discharge. We categorized hospitals into quartiles based on ticagrelor utilization rates. The primary composite outcome was 1-year death or hospitalization for MI/UA, and 1-year bleeding hospitalization was a secondary outcome. Outcomes were evaluated using a Cox proportional hazards model to compare high vs. low utilization groups. Further, we quantified the between-hospital variability of ticagrelor utilization using multi-level logistic regression analysis, expressed as median odds ratios (MOR). Results: Among 23 962 patients in our cohort, 42.5% were prescribed ticagrelor ≤7 days post-hospital discharge. Ticagrelor utilization increased from 32.6% in 2014 to 51.8% in 2017. Hospitals at the lowest quartile of ticagrelor utilization (<8.8%) had a higher hazard of the primary outcome (adjusted hazard ratio: 1.27 95%CI: 1.11-1.46, p<0.001) compared with high ticagrelor utilization hospitals (>40%). No significant difference in bleeding hospitalization across hospital quartiles was observed. Some factors associated with higher ticagrelor use were cardiologist as most responsible physician during index hospitalization and urban hospital. After adjusting for patient-, prescriber- and hospital-level characteristics, substantial variation remained between hospitals in the likelihood of patients receiving ticagrelor at discharge (MOR: 2.54). Conclusion: Increasing trends of ticagrelor utilization were observed. Ticagrelor utilization rates varied across hospitals, and hospitals with higher ticagrelor adoption were associated with better clinical outcomes.

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Abstract 14873: Is There Difference in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) between Hospitals With and Without Onsite Cardiac Surgery Backup?

Circulation ◽

10.1161/circ.130.suppl_2.14873 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tomonori Akasaka ◽

Seiji Hokimoto ◽

Noriaki Tabata ◽

Kenji Sakamoto ◽

Kenichi Tsujita ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Bleeding Complications ◽

Hospital Death ◽

Coronary Syndrome ◽

Significant Difference ◽

The Impact

Background: Based on 2011 ACCF/AHA/SCAI PCI guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent data suggests that there is no significant difference in clinical outcomes following primary or elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI to ACS. Methods: From Aug 2008 to March 2011, subjects (n=2288) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=1954) or without (n=334) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored other events those were non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG. Results: There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery (9.6%vs9.5%; P=0.737). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite cardiac surgery (22.1%vs12.9%; P<0.001). Kaplan-Meier analysis for primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.943). By cox proportional hazards model analysis for primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 0.969, 95%CI 0.704-1.333; P=0.845). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (6.9% vs 8.0%; P=0.544). Conclusions: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽

10.3390/antibiotics10020105 ◽

2021 ◽

Vol 10 (2) ◽

pp. 105

Author(s):

Jatapat Hemapanpairoa ◽

Dhitiwat Changpradub ◽

Sudaluck Thunyaharn ◽

Wichai Santimaleeworagun

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Proportional Hazards Model ◽

Significant Risk ◽

Vancomycin Resistance ◽

Cox Proportional Hazards Model ◽

Factors Associated ◽

Joint Infections ◽

Bone And Joint Infections ◽

The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

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Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

International Journal of Angiology ◽

10.1055/s-0041-1722875 ◽

2021 ◽

Author(s):

Anwar Santoso ◽

Yulianto Yulianto ◽

Hendra Simarmata ◽

Abhirama Nofandra Putra ◽

Erlin Listiyaningsih

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

Cerebrovascular Events ◽

St Segment ◽

Significant Difference

AbstractMajor adverse cardio-cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) are still high, although there have been advances in pharmacology and interventional procedures. Proprotein convertase subtilisin/Kexin type 9 (PCSK9) is a serine protease regulating lipid metabolism associated with inflammation in acute coronary syndrome. The MACCE is possibly related to polymorphisms in PCSK9. A prospective cohort observational study was designed to confirm the association between polymorphism of E670G and R46L in the PCSK9 gene with MACCE in STEMI. The Cox proportional hazards model and Spearman correlation were utilized in the study. The Genotyping of PCSK9 and ELISA was assayed.Sixty-five of 423 STEMI patients experienced MACCE in 6 months. The E670G polymorphism in PCSK9 was associated with MACCE (hazard ratio = 45.40; 95% confidence interval: 5.30–390.30; p = 0.00). There was a significant difference of PCSK9 plasma levels in patients with previous statin consumption (310 [220–1,220] pg/mL) versus those free of any statins (280 [190–1,520] pg/mL) (p = 0.001).E670G polymorphism of PCSK9 was associated with MACCE in STEMI within a 6-month follow-up. The plasma PCSK9 level was higher in statin users.

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Assessment of preparation time and 1-year Invisalign aligner attachment survival using flowable and packable composites:

The Angle Orthodontist ◽

10.2319/063020-598.1 ◽

2021 ◽

Author(s):

Shuang Lin ◽

Ling Huang ◽

Jialing Li ◽

Juan Wen ◽

Li Mei ◽

...

Keyword(s):

Survival Data ◽

Tooth Extraction ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Secondary Outcome ◽

Preparation Time ◽

Cox Models ◽

Significant Difference

ABSTRACT Objectives To compare preparation time and 1-year Invisalign aligner attachment survival between a flowable composite (FC) and a packable composite (PC). Materials and Methods Fifty-five participants (13 men and 42 women, mean age ± SD: 24.2 ± 5.9 years) were included in the study. Ipsilateral quadrants (ie, maxillary and mandibular right, or vice versa) of attachments were randomly assigned to the FC group (Filtek Z350XT Flowable Restorative) and the PC group (Filtek Z350XT Universal Restorative) by tossing a coin. The primary outcome was preparation time. The secondary outcome was time to the first damage of an attachment. Preparation times were compared using the paired t-test, and the survival data were analyzed by the Cox proportional hazards model with a shared frailty term, with α = .05. Results The preparation times were significantly shorter with the FC (6.22 ± 0.22 seconds per attachment) than with the PC (32.83 ± 2.16 seconds per attachment; P < .001). The attachment damage rates were 14.79% for the FC and 9.70% for the PC. According to the Cox models, attachment damage was not significantly affected by the attachment material, sex, arch, tooth location, attachment type, presence of overbite, or occurrence of tooth extraction. Conclusions The use of a FC may save time as compared with the use of a PC. With regard to attachment survival, there was no significant difference between the two composites. None of the covariates of attachment materials (sex, arch, tooth location, attachment type, presence of overbite, oir occurrence of tooth extraction) affected attachment damage.

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Factors Associated With U.S. Army Physician Service After Obligation Completion

Military Medicine ◽

10.1093/milmed/usy263 ◽

2018 ◽

Vol 184 (7-8) ◽

pp. e329-e336 ◽

Cited By ~ 3

Author(s):

Andrew R Wiesen ◽

Rodd E Marcum ◽

Michele A Soltis ◽

Kris A Peterson

Keyword(s):

Medical School ◽

Military Service ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Physician Service ◽

Factors Associated ◽

Significant Difference ◽

Active Service

Abstract Introduction Approximately, 320 physicians enter active duty in the U.S. Army each year, replacing a similar number separating from service. Despite the significant costs involved in educating and training physicians, factors associated with continued active service after completing obligations have not been well studied. Materials and Methods A retrospective cohort study was conducted of all U.S. Army physicians who graduated medical school in 1987 or later and entered active physician service on or before December 31, 2015. A Cox proportional hazards model was used to evaluate the likelihood of continued service after initial obligations to the Army were satisfied. A logistic regression model examined the likelihood of reaching retirement eligibility for the subgroup entering service before October 1998. Results Of the 10,490 physicians who met inclusion criteria, 8,009 physicians completed their service obligation by the end of the study. There were 4,524 physicians who entered service before October 1998 and were eligible for the retirement analysis. Several factors were found to be independently associated with a higher likelihood of continued post-obligation service and reaching retirement eligibility. These factors were: years of active service accumulated when obligations were complete; preventive medicine and infectious disease specialization; and male gender. Conclusions The physicians most likely to continue serving after completion of their obligation and ultimately retire are those who had the most years of service accumulated when they could leave the Army. Graduates from the Uniformed Services University of the Health Sciences (USU) incur an obligation of 7 years vs. 4 years for most other programs. USU also attracts a higher proportion of applicants with prior military service and pre-medical school service obligations. The lack of significant difference in service after obligation completion or achievement of retirement eligibility between USU and non-USU graduates was explained by the greater total service of USU graduates when their obligations were complete. Changing the obligation and incentives, such as salary, for other accessioning programs to mirror the USU model would likely minimize service differences between USU and non-USU graduates.

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Tocilizumab in Hospitalized Patients with Severe COVID-19: An Open Label, Prospective Study

10.21203/rs.3.rs-824171/v1 ◽

2021 ◽

Author(s):

Theodoros Karampitsakos ◽

Elli Malakounidou ◽

Ourania Papaioannou ◽

Vasilina Dimakopoulou ◽

Eirini Zarkadi ◽

...

Keyword(s):

Prospective Study ◽

Usual Care ◽

Clinical Outcomes ◽

Usual Care Group ◽

Proportional Hazards Model ◽

Hospitalized Patients ◽

Cox Proportional Hazards Model ◽

Care Group ◽

Open Label ◽

Significant Difference

Abstract Background: Data on the safety and efficacy profile of tocilizumab in patients with severe COVID-19 needs to be enriched.Methods: In this open label, prospective study, we evaluated clinical outcomes in consecutive patients with COVID-19 and PaO2/FiO2<200 receiving tocilizumab plus usual care versus usual care alone. The primary outcome was 28-day mortality. Secondary outcomes included time to discharge, change in PaO2/FiO2 at day 5 and change in WHO progression scale at day 10.Findings: Overall, 114 patients were included in the analysis (tocilizumab plus usual care: 56, usual care: 58). Allocation to usual care was associated with significant increase in 28-day mortality compared to tocilizumab plus usual care [Cox proportional-hazards model: HR: 3.34, (95%CI: 1.21 to 9.30), (p=0.02)]. There was not a statistically significant difference with regards to hospital discharge over the 28-day period for patients receiving tocilizumab compared to usual care [11.0 days (95%CI: 9.0 to 16.0) vs 14.0 days (95%CI: 10.0 to 24.0), HR: 1.32 (95%CI: 0.84 to 2.08), p=0.21]. ΔPaO2/FiO2 at day 5 was significantly higher in the tocilizumab group compared to the usual care group [42.0 (95%CI: 23.0 to 84.7) vs 15.8 (95%CI: -19.4 to 50.3), p=0.03]. ΔWHO scale at day 10 was significantly lower in the tocilizumab group compared to the usual care group (-0.5±2.1 vs 0.6±2.6, p=0.005). Conclusion: This is the first study administrating tocilizumab in patients with COVID-19 based on PaO2/FiO2. Tocilizumab improved survival and other clinical outcomes in hospitalized patients with COVID-19 and PaO2/FiO2<200 irrespective of systemic inflammatory markers levels.

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Soluble ST2 and Galectin-3 as Predictors of Chronic Kidney Disease Progression and Outcomes

American Journal of Nephrology ◽

10.1159/000513663 ◽

2021 ◽

Vol 52 (2) ◽

pp. 119-130

Author(s):

Ae Jin Kim ◽

Han Ro ◽

Hyunsook Kim ◽

Jae Hyun Chang ◽

Hyun Hee Lee ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards Model ◽

Cox Regression ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Secondary Outcome ◽

Composite Outcome ◽

Ckd Progression ◽

Cox Regression Analysis ◽

Galectin 3

Background: Soluble suppression of tumorigenicity-2 (sST2) and galectin-3, novel biomarkers of heart failure and cardiovascular stress, predict cardiovascular events (CVEs) and mortality. However, their relationship with kidney function and adverse outcomes in CKD are uncertain. The purpose of this study was to determine the association between sST2 and galectin-3 with CKD progression and adverse clinical outcomes. Methods: We measured baseline sST2 and galectin-3 levels in the CKD patient cohort at our institution between October 2013 and December 2014. The primary outcome was CKD progression (kidney failure with replacement therapy or ≥50% reduction in estimated glomerular filtration rate from the baseline). The secondary outcome was the composite of CVEs and death. We used a Cox proportional hazards model to evaluate the associations between sST2 and galectin-3 levels, with kidney and clinical outcomes. Results: In total, 352 patients were enrolled in this study. At baseline, log sST2 and galectin-3 were directly associated with the serum creatinine (Cr) and urine protein-to-Cr ratio. Cox regression analysis showed that the baseline log sST2 level independently predicted CKD progression and composite outcome after adjustment for age, sex, smoking, diabetes mellitus, hypertension, cardiovascular disease, renin-angiotensin system blocker, calcium channel blocker, β-blocker, diuretics, antiplatelet agents, anemia, and hypoalbuminemia. The baseline log galectin-3 level was independently associated with CKD progression, but not with the composite outcome after adjustment for confounding variables. Conclusions: Elevated levels of sST2 and galectin-3 are significantly associated with CKD progression, but only sST2 is associated with adverse clinical outcomes.

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Effect of chest-compression-only bystander cardiopulmonary resuscitation on the likelihood of initial shockable rhythm after out-of-hospital cardiac arrest: a propensity matching analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1829 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Funada ◽

Y Goto ◽

T Maeda ◽

H Okada ◽

M Takamura

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Shockable Rhythm ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr

Abstract Background/Introduction Shockable rhythm after cardiac arrest is highly expected after early initiation of bystander cardiopulmonary resuscitation (CPR) owing to increased coronary perfusion. However, the relationship between bystander CPR and initial shockable rhythm in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that chest-compression-only CPR (CC-CPR) before emergency medical service (EMS) arrival has an equivalent effect on the likelihood of initial shockable rhythm to the standard CPR (chest compression plus rescue breathing [S-CPR]). Purpose We aimed to examine the rate of initial shockable rhythm and 1-month outcomes in patients who received bystander CPR after OHCA. Methods The study included 59,688 patients (age, ≥18 years) who received bystander CPR after an OHCA with a presumed cardiac origin witnessed by a layperson in a prospectively recorded Japanese nationwide Utstein-style database from 2013 to 2017. Patients who received public-access defibrillation before arrival of the EMS personnel were excluded. The patients were divided into CC-CPR (n=51,520) and S-CPR (n=8168) groups according to the type of bystander CPR received. The primary end point was initial shockable rhythm recorded by the EMS personnel just after arrival at the site. The secondary end point was the 1-month outcomes (survival and neurologically intact survival) after OHCA. In the statistical analyses, a Cox proportional hazards model was applied to reflect the different bystander CPR durations before/after propensity score (PS) matching. Results The crude rate of the initial shockable rhythm in the CC-CPR group (21.3%, 10,946/51,520) was significantly higher than that in the S-CPR group (17.6%, 1441/8168, p<0.0001) before PS matching. However, no significant difference in the rate of initial shockable rhythm was found between the 2 groups after PS matching (18.3% [1493/8168] vs 17.6% [1441/8168], p=0.30). In the Cox proportional hazards model, CC-CPR was more negatively associated with the initial shockable rhythm before PS matching (unadjusted hazards ratio [HR], 0.97; 95% confidence interval [CI], 0.94–0.99; p=0.012; adjusted HR, 0.92; 95% CI, 0.89–0.94; p<0.0001) than S-CPR. After PS matching, however, no significant difference was found between the 2 groups (adjusted HR of CC-CPR compared with S-CPR, 0.97; 95% CI, 0.94–1.00; p=0.09). No significant differences were found between C-CPR and S-CPR in the 1-month outcomes after PS matching as follows, respectively: survival, 8.5% and 10.1%; adjusted odds ratio, 0.89; 95% CI, 0.79–1.00; p=0.07; cerebral performance category 1 or 2, 5.5% and 6.9%; adjusted odds, 0.86; 95% CI, 0.74–1.00; p=0.052. Conclusions Compared with S-CPR, the CC-CPR before EMS arrival had an equivalent multivariable-adjusted association with the likelihood of initial shockable rhythm in the patients with OHCA due to presumed cardiac causes that was witnessed by a layperson. Funding Acknowledgement Type of funding source: None

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Abstract MP74: It's Not Too Late to Improve Adherence: Association Between All-Cause Mortality and Statin Adherence Change After Acute Myocardial Infarction

Circulation ◽

10.1161/circ.137.suppl_1.mp74 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Ryan P Hickson ◽

Jennifer G Robinson ◽

Izabela E Annis ◽

Ley A Killeya-Jones ◽

Gang Fang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Proportional Hazards Model ◽

Reference Group ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Administrative Claims ◽

Post Discharge ◽

All Cause Mortality ◽

Statin Adherence

Introduction: Hospitalization for acute myocardial infarction (AMI) affects medication adherence in prevalent statin users. Our objective was to estimate the association between changes in statin adherence and all-cause mortality after AMI discharge. Hypothesis: Patients who are adherent both pre- and post-AMI have the lowest risk of all-cause mortality. Methods: Medicare administrative claims were used to identify AMI hospitalizations in 2008-2010. Patients were ≥66 years old, continuously enrolled ≥360 days pre-AMI with a statin prescription claim, discharged to home/self-care, and survived ≥180 days post-AMI with continuous enrollment. Statin adherence was measured in the 180 days pre- and post-AMI hospitalization using proportion of days covered and categorized as severely nonadherent, moderately nonadherent, and adherent. The exposure was categorical change in statin adherence from pre- to post-AMI (9 categories, see Figure); adherent/adherent was the reference group. Patients were followed for all-cause mortality from 180 days post-discharge for up to 18 months. A multivariable Cox proportional hazards model estimated hazard ratios (HRs). Results: Of 101,011 eligible patients, 15% decreased, 20% increased, and 64% did not change statin adherence categories. Compared to patients who were adherent pre- and post-AMI, the adjusted HR (95% confidence intervals [CIs]) for patients who increased from severely nonadherent to adherent was 0.93 (95% CI: 0.85-1.02); other increases in adherence had similar HRs (see Figure). Compared to patients who were adherent pre- and post-AMI, the adjusted HR for patients who decreased from adherent to severely nonadherent was 1.22 (95% CI: 1.13-1.33); other decreases in adherence had similar HRs. Conclusions: Although patients with decreased statin adherence had the worst mortality outcomes, those with increased adherence had similar or better outcomes than continuously adherent patients, showing that, even after an AMI, it is not too late to improve statin adherence.

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Abstract 15567: Residual Cholesterol and Cardiovascular Events in Patients With Coronary Artery Disease Under Different Glucose Metabolism Status

Circulation ◽

10.1161/circ.142.suppl_3.15567 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jian-jun Li ◽

Yexuan Cao ◽

Hui-Wen Zhang ◽

Jing-Lu Jin ◽

Yan Zhang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Glucose Metabolism ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Significant Difference ◽

Artery Disease

Introduction: The atherogenicity of residual cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM). Hypothesis: This study aimed to examine the prognostic value of plasma RC, clinically presented as triglyceride-rich lipoprotein-cholesterol (TRL-C) or remnant-like lipoprotein particles-cholesterol (RLP-C), in CAD patients with different glucose metabolism status. Methods: Fasting plasma TRL-C and RLP-C levels were directly calculated or measured in 4331 patients with CAD. Patients were followed for incident MACEs for up to 8.6 years and categorized according to both glucose metabolism status [DM, pre-DM, normal glycaemia regulation (NGR)] and RC levels. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. Results: During a mean follow-up of 5.1 years, 541 (12.5%) MACEs occurred. The risk for MACEs was significantly higher in patients with elevated RC levels after adjustment for potential confounders. No significant difference in MACEs was observed between pre-DM and NGR groups (p>0.05). When stratified by status of glucose metabolism and RC levels, highest levels of RLP-C, calculated and measured TRL-C were significant and independent predictors of developing MACEs in pre-DM (HR: 2.10, 1.98, 1.92, respectively; all p<0.05) and DM (HR: 2.25, 2.00, 2.16, respectively; all p<0.05). Conclusions: In this large cohort study with long-term follow-up, data firstly demonstrated that higher RC levels were significantly associated with the worse prognosis in DM and pre-DM patients with CAD, suggesting RC might be a target for patients with impaired glucose metabolism.

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