Malondialdehyde-modified low-density lipoprotein is a predictor of cardiac events in patients with stable angina on lipid-lowering therapy after percutaneous coronary intervention using drug-eluting stent. Issue 2 (April 2015)

• Record Type: Journal Article
• Authors: Ito, Tsuyoshi; Fujita, Hiroshi; Tani, Tomomitsu; Ohte, Nobuyuki
• Is Part Of: Atherosclerosis. Volume 239:Issue 2(2015)
• Page Start: 311
• Page End: 317
• Publication Date: 2015-04
• Subjects: Malondialdehyde-modified low-density lipoprotein -- Clinical outcomes -- Drug-eluting stent; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2015.01.026
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Objective: Patients undergoing lipid-lowering therapy after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) are subject to residual risk. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is suggested as a marker of the initiation and acceleration of atherosclerosis. This study aimed to investigate the impact of MDA-LDL on clinical outcomes in patients with stable angina undergoing lipid-lowering therapy after DES implantation. Methods: In this study, 332 patients whose MDA-LDL was measured before PCI with DES were followed clinically (median 2.9 years). Lipid-lowering therapy was conducted, with the target LDL ≤100 mg/dL. We analyzed the composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and any revascularization. Results: MACE was observed in 64 patients (19.3%). MDA-LDL was significantly higher in the MACE group (139.1 ± 53.2 U/L vs. 106.5 ± 38.3 U/L, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and hemodialysis (Hazard ratio (HR) 4.60; p < 0.01), MDA-LDL (per 10 U/L, HR 1.14; p < 0.01), multivessel disease (HR 1.78; p = 0.02), and high-density lipoprotein (per 10 mg/dL, HR 0.79; p = 0.03). In the multivariate model, hemodialysis (HR 4.10; p < 0.01) and MDA-LDL (per 10U/L, HR 1.10; p < 0.01) remained significant predictors of MACE. The optimal MDA-LDL threshold for predicting MACE was 114.1 U/L, identified by the receiver operating characteristic curve. Conclusions: MDA-LDL was associated with future cardiac events in patients with stable angina that underwent lipid-lowering therapy after DES-PCI. Highlights: Patients undergoing lipid-lowering therapy after PCI are subject to residual risk. MDA-LDL is suggested as a marker o atherosclerosis. This study aimed to investigate the impact of MDA-LDL on clinical outcomes after PCI. MDA-LDL level was associated with future cardiac events in patients after PCI.