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Published on: January 28, 2020
Triglyceride levels and all-cause mortality in patients with left main coronary artery disease undergoing
HongJing Lu1, Yufeng Yan1, Haimei Xu1
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
Low triglyceride (TG) levels are linked to increased long-term mortality in patients with left main coronary artery disease (LMCAD) after percutaneous coronary intervention (PCI). This finding highlights TG as a crucial prognostic marker in this high-risk population.
Area of Science:
- Cardiology
- Lipid Metabolism
- Clinical Outcomes Research
Background:
- Triglycerides (TG) and triglyceride-rich lipoproteins are implicated in atherosclerosis development.
- The prognostic significance of TG levels in patients with left main coronary artery disease (LMCAD) is not well understood.
Purpose of the Study:
- To investigate the association between TG levels and long-term mortality in patients with LMCAD undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective study of 2,778 LMCAD patients treated with PCI.
- Restricted cubic splines (RCS) modeled the TG-mortality relationship.
- An optimal TG cutoff was identified to stratify patients into high-TG and low-TG groups.
Main Results:
- A linear inverse relationship was observed between TG levels and all-cause mortality.
- A TG cutoff of 0.93 mmol/L identified a low-TG group with significantly higher all-cause mortality (17.2% vs. 11.5%).
- Low TG levels were independently associated with increased all-cause mortality (adjusted HR: 1.379) and cardiovascular mortality.
Conclusions:
- Low triglyceride levels serve as an independent prognostic factor for all-cause mortality in LMCAD patients post-PCI.
- These findings underscore the importance of monitoring TG levels for risk stratification in this patient cohort.
Backgrounds:
Triglycerides (TG) and triglyceride-rich lipoproteins contribute to the development and progression of atherosclerosis. However, the prognostic value of TG levels in patients with left main coronary artery disease (LMCAD) remains unexplored. This study aimed to examine the association between TG levels and long-term mortality within this population.
Methods:
We conducted a single-center retrospective study of 2,778 patients with LMCAD undergoing percutaneous coronary intervention (PCI). We modeled the association between TG levels and the hazard ratio (HR) for mortality using restricted cubic splines (RCS). An optimal TG cutoff for stratification was identified using the maximum selected rank statistic, and patients were then divided into two groups. We assessed the proportional hazards assumption with plots of Schoenfeld residuals. The primary endpoint was all-cause death. Secondary endpoints included cardiovascular death, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization.
Results:
Over a mean follow-up of 47.4 ± 30.3 months, 351 (12.6%) patients died, including 207 cardiovascular deaths. Restricted cubic spline analysis showed a linear inverse relationship between TG levels and all-cause mortality. An optimal TG cutoff of 0.93 mmol/L was identified, dividing patients into high-TG (n = 2214) and low-TG (n = 564) groups. The low-TG group had significantly higher all-cause mortality (17.2% vs. 11.5%, log-rank P<0.001). After multivariable adjustment, low TG remained independently associated with a higher risk of all-cause mortality [adjusted HR: 1.379; 95% confidence interval (CI): 1.069-1.778; P = 0.013]. The low-TG group was also associated with a higher risk of cardiovascular mortality (9.4% vs. 7.0%, log-rank P = 0.011). No significant associations were observed between TG levels and other secondary endpoints. Subgroup analyses confirmed the consistent prognostic value of TG across clinical subgroups.
Conclusion:
Our findings indicate that low TG levels are an independent prognostic factor for all-cause mortality among LMCAD patients undergoing PCI.
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