Background:Cardiac events can occur after drug-eluting stent (DES) implantation due to coronary plaque progression at non-stented sites. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is suggested to be an atherogenic marker. This study investigated the relationship between serum MDA-LDL and angiographic progression after DES implantation.

Methods and Results:In total, 207 patients who underwent percutaneous coronary intervention (PCI) using DES and follow-up coronary angiography were retrospectively analyzed. MDA-LDL was serially measured before PCI and at follow up. Persistent high MDA-LDL was defined as a MDA-LDL level more than the median value both before PCI and at follow up. Angiographic progression was assessed by serial analysis of quantitative coronary angiography. Angiographic progression occurred in 35 patients (16.9%). MDA-LDL before PCI was significantly higher in the progression group than the non-progression group in all patients (143.4±35.8 U/L vs. 103.0±33.5U/L, P<0.001) and in patients with controlled LDL-cholesterol (LDL-C <100 mg/dL both before PCI and at follow up; 121.8±32.7 U/L vs. 84.9±24.9 U/L, P<0.001). There were positive correlations between % diameter stenosis changes and serum MDA-LDL before PCI in all patients (r=0.33, P<0.01) and those with controlled LDL-C (r=0.23, P=0.04). In multivariate logistic regression analysis, persistent high MDA-LDL was an independent predictor of plaque progression.

Conclusions:Increased serum MDA-LDL was associated with angiographic progression after DES implantation.

背景：药物洗脱支架（DES）植入后，由于非支架部位的冠状动脉斑块进展，可能发生心脏事件。丙二醛修饰的低密度脂蛋白（MDA-LDL）被认为是致动脉粥样硬化的标志物。本研究调查了DES植入后血清MDA-LDL与血管造影进展之间的关系。

方法和结果：回顾性分析了总共207例使用DES进行经皮冠状动脉介入治疗（PCI）和随访冠状动脉造影的患者。在PCI之前和随访时对MDA-LDL进行了串行测量。持续性高MDA-LDL定义为MDA-LDL水平高于PCI之前和随访时的中值。通过定量冠状动脉造影的系列分析评估血管造影的进展。35例患者发生了血管造影进展（16.9％）。在所有患者中，进展前组中PCI之前的MDA-LDL均显着高于未进展组（143.4±35.8 U / L vs. 103.0±33.5U / L，P <0.001）和LDL-胆固醇控制的患者（ PCI前和随访时LDL-C <100 mg / dL; 121.8±32.7 U / L vs. 84.9±24.9 U / L，P <0.001）。在所有患者（r = 0.33，P <0.01）和控制LDL-C的患者（r = 0.23，P = 0.04）之间，％狭窄率变化与PCI前血清MDA-LDL呈正相关。在多元逻辑回归分析中，持续的高MDA-LDL是斑块进展的独立预测因子。

结论： DES植入后血清MDA-LDL升高与血管造影进展有关。