Associations between lipid profiles and MACE in hemodialysis patients with percutaneous coronary intervention: From the FU-Registry. Issue 2 (February 2015) - Nagata, Itsuki
Abstract Background It is well known that percutaneous coronary intervention (PCI) in hemodialysis (HD) patients is associated with higher rates of in-stent restenosis and major adverse cardiovascular events (MACE) compared to that in non-HD patients, even if the target value in cholesterol management is achieved. Methods To evaluate the factors that are associated with MACE in HD patients, we selected 142 HD patients (164 lesions) without acute coronary syndrome (ACS) from 2148 patients (2568 lesions) who underwent PCI in our database of the FU-Registry [UMIN000005679, Fukuoka University Hospital EC/IRB:10-1-08(09-105)], and compared 52 patients (53 lesions) with MACE [MACE(+)] to 90 patients (111 lesions) without MACE [MACE(−)]. Results Total cholesterol (TC: 150 ± 30 mg/dL vs 166 ± 39 mg/dL, p < 0.05) and high-density lipoprotein cholesterol (HDL-C: 40.1 ± 14.7 mg/dL vs 47.8 ± 13.5 mg/dL, p < 0.01) levels were significantly lower in the MACE(+) group at follow-up. No significant differences were observed in other parameters, including triglyceride, low-density lipoprotein cholesterol (LDL-C; LDL-C/HDL-C ratio, and % changes in HDL-C, non-HDL-C, LDL-C), and hemoglobin A1c (US National Glycohemoglobin Standardization Program) between before and after PCI. TC, LDL-C, and non-HDL-C at the time of PCI and TC, and HDL-C at the 9-month follow-up were negatively correlated with MACE, while body mass index (BMI) [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.68–0.95)], prior coronary artery bypass graft (CABG) (OR: 3.89; 95%CI: 1.29–12.6), and insulin use (OR: 3.17; 95%CI: 1.23–8.55) were strongly correlated with MACE in a multivariate analysis. Conclusion BMI, CABG, and insulin use, but not LDL-C, are independent predictors of MACE in HD patients, suggesting that the application of lipid management for non-HD patients to HD patients at the time of PCI may not necessarily be beneficial for medium-term clinical outcomes.