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ȣ - 530479 286 |
| The Reduction of Apolipoprotein B/A-I Ratio Predicts Favorable Long-term Outcome After Acute Myocardial Infarction |
| 전남대학교병원 심장센터, 보건복지가족부 지정 심장질환 특성화 연구센터 |
| 조재영, 정명호, 안영근, 홍영준, 심두선, 박근호, 박형욱, 윤남식, 윤현주, 김계훈, 김주한, 조정관, 박종춘, 강정채, 박옥규 |
Background: Apolipoprotein B transports all potentially atherogenic very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) particles, while apolipoprotein A-I acts as the major antiatherogenic protein in the high-density lipoprotein (HDL) particles. Therefore, apolipoprotein B/apolipoprotein A-I ratio (ApoB/A-I ratio) could be a risk factor for CAD. The aim of this study was to assess the influence of the reduction of ApoB/A-I ratio on the outcome after acute myocardial infarction. Methods: Between November 2005 to September 2007, we measured serum Lp (a), ApoB and ApoA-I level in 1,014 consecutive AMI patients (63.7±12.4 years, 723 men) on admission and six-month follow-up. We divided patients into two groups according to ApoB/A-I ratio reduction (Group I: ApoB/A-I ratio on admission>six-month follow-up, Group II: ApoB/A-I ratio on admission≤six-month follow-up). Results: There were more men in Group I (78.0% vs. 22.0%, p=0.030) but, no significant differences in age between groups. Particularly, group II showed better left ventricular ejection fraction than group I (56.2±11.1 vs. 57.3±14.3 %, p=0.003). There were more TIMI 0 flows in Group I (44.8%) while more TIMI 3 flows (40.7%) in Group II(p=0.033). There were significant differences between two groups in analysis of cardiac enzyme, CK (1541.0±1680.0 vs. 1770.0±2529.1 U/L, p=0.003) and CK-MB level (93.5±104.6 vs. 104.4±131.5 U/L, p=0.010) were higher in Group II than Group I. Lipoprotein (a) level was also higher in group II (30.7±25.6 vs. 31.6±36.1 mg/dl, p=0.018). Especially, the majority of patients in group I were administered statins (94.2% vs. 69.8%, p<0.0001). In analysis of clinical outcomes, one-year major cardiac adverse events (MACE) was higher than in group II (17.1 vs. 21.6 %, p=0.032). In Kaplan-Meier analysis, group I showed more favorable MACE-free survival rate than that of group II (p<0.0001 by Log-Rank test). Conclusion: The reduction of ApoB/A-I ratio predicts favorable long-term outcome after AMI and statin therapy maybe beneficial to clinical outcomes in AMI patients with high ApoB/A-I level.
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