title: 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.
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 ± 53.2U/L vs. 106.5 ± 38.3U/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 10U/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 114.1U/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.
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: tuyosiito@gmail.com.
authors: Tsuyoshi
authors: T
authors: Ito
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Hiroshi
authors: H
authors: Fujita
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Tomomitsu
authors: T
authors: Tani
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Nobuyuki
authors: N
authors: Ohte
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000097:blood* / Q000188:drug therapy*; D050197:Atherosclerosis / Q000097:blood* / Q000188:drug therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008077:Lipoproteins, LDL / Q000737:chemistry*; D008297:Male; D008315:Malondialdehyde / Q000737:chemistry*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015427:Reperfusion Injury; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D008315:Malondialdehyde
keywords: Clinical outcomes; Drug-eluting stent; Malondialdehyde-modified low-density lipoprotein