Impact of malondialdehyde-modified low-density lipoprotein on clinical outcomes after fractional flow reserve-guided def
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ORIGINAL ARTICLE
Impact of malondialdehyde‑modified low‑density lipoprotein on clinical outcomes after fractional flow reserve‑guided deferral of revascularization Masashi Yokoi1 · Tsuyoshi Ito1 · Hiroshi Fujita1 · Tomonori Sugiura1 · Yoshihiro Seo1 · Nobuyuki Ohte1 Received: 3 September 2020 / Accepted: 6 November 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Cardiovascular events can occur after deferred revascularization, and malondialdehyde-modified low-density lipoprotein (MDA-LDL) has been suggested to be an atherogenic marker. We investigated the relationship between serum MDA-LDL levels and clinical outcomes in patients with fractional flow reserve (FFR)-guided deferral of revascularization. Among 3084 patients undergoing coronary angiography, we retrospectively analyzed 127 patients with intermediate stenosis and deferred revascularization based on FFR > 0.80. Median follow-up interval was 30.4 months, and serum MDA-LDL was measured prior to the measurement of FFR. We evaluated the composite of major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, ischemia-driven deferred lesion revascularization, and any revascularization. MACEs occurred in 18 (14.2%) patients. The MACE group presented with significantly higher MDA-LDL levels than the non-MACE group (134.9 ± 33.3 U/L vs. 95.6 ± 32.2 U/L, P 0.80 is associated with favorable clinical outcomes under optimal medical therapy [3]. On the other hand, some patients experience * Tsuyoshi Ito [email protected] 1
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, Aichi 4678601, Japan
cardiac events after FFR-guided deferred revascularization to various rates according to the patient’s comorbidities and clinical setting [4–9]. Therefore, it is important to stratify patients who are at risk and optimize therapy after deferral of revascularization. Oxidative modification of lowdensity lipoprotein (LDL) plays a key role in the formation and acceleration of atherosclerosis [10]. Malondialdehydemodified low-density lipoprotein (MDA-LDL), an epitope of oxidized LDL, was recently shown to be a marker of CAD severity [11] and plaque vulnerability [12, 13], as well as a predictor of plaque progression [14] and adverse cardiac events after drug-eluting stent implantation [15]. Until now, it remains unclear whether abnormal serum MDALDL levels are associated with adverse cardiac events after FFR-guided deferral of revascularization. The aim of this study was to investigate the impact of serum MDA-LDL on
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Heart and Vessels
clinical outcomes in patients with stable CAD after deferral of revascularization based on FFR > 0.80.
Materials and methods Study population From April 2011 to December 2018, a total of 3084 patients suspected of CAD underwent coronary angiography (CAG) at our institute, including 336 patients who presented with one or more angiographically intermediate lesions and underwent FFR measurements. Among these
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