[Normalization of lipid metabolism disturbances and clinical course after percutaneous coronary angioplasty: 6 month observation].
The recurrent stenosis of previously successfully dilated coronary arteries still remains a matter of concern despite of the improved short and long term results of percutaneous coronary angioplasty. The role of dyslipidaemia in the origin of restenosis after coronary angioplasty is still controversial. The aim of our study was to evaluate the efficacy of hypolipemic treatment in patients undergoing coronary angioplasty and to find out whether successful lowering of lipid parameters to normal limits is related to improvement exercise capacity and systolic function of left ventricle. The study group comprised 152 patients (17 women, 135 men), aged 52 +/- 8.8 years, who were reffered for percutaneous coronary angioplasty (PTCA). The patients were divided, according to the ratio of total cholesterol to HDL cholesterol (CH/ch-HDL), into two subgroups: subgroup I with CH/ch-HDL > 5.0 and subgroup II with CH/ch-HDL < or = 5.0. In all patients following parameters: total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and body mass index were measured before PTCA, 1 month and 6 months after the procedure. At the same times a treadmill test and echocardiography were performed. Baseline total cholesterol, HDL cholesterol and triglycerides were significantly higher in subgroup I. In subgroup I Ch/ch-HDL ratio was at baseline 7.4 +/- 2.0 and decreased 6 months after PTCA to 5.2 +/- 1.7, p < 0.001. The CH/ch-HDL ratio was 4.2 +/- 0.6 in subgroup II before PTCA and remained the same 4.1 +/- 1.2 after 6 months. Before PTCA, the exercise capacity did not differ between groups 9.1 +/- 2.5 vs 9.6 +/- 3.3 MET, p = ns. A significant improvement of exercise capacity was observed in subgroup I 1 month after PTCA 9.1 +/- 2.5 to 11.2 +/- 2.7 MET, p < 0.001, remaining at the same level after 6 months. The differences seen in group II did not reach the statistical significance. Echocardiography revealed improvement of left ventricle contractility in both subgroups, with statistically significant increase in group I (1.24 +/- 0.36 to 1.14 +/- 0.27, p < 0.001). The left ventricle systolic function was within normal limits in all patients before coronary angioplasty and increased significantly 1 month after PTCA in subgroup I (56.1 to 60.4%, p < 0.001). 6 months after PTCA no further significant changes were observed.


CONCLUSIONS
The dyslipidaemic state recognised before PTCA does not influence clinical outcomes after the procedure. Lipid lowering therapy should be offered to every patient undergoing coronary angioplasty regardless of the baseline value of total cholesterol to HDL cholesterol ratio. Optimal treatment of dyslipidaemia leading to lower total cholesterol, triglycerides and total cholesterol to HDL cholesterol ratio, to normal limits, is associated with improved exercise capacity and systolic function of left ventricle six months after successful coronary angioplasty.
Ochała
A
A
Gabrylewicz
B
B
Bartnik
M
M
Garbocz
P
P
Wycisk
A
A
Lewicki
A
A
Kaźmierski
M
M
Tendera
M
M
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000150:complications* / Q000628:therapy*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control
D008076:Cholesterol, HDL; D002784:Cholesterol