Abstract 14969: Association Between Apolipoprotein A-I and Ischemia Risk at Different Diabetes Statuses in Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Real-World Study

Introduction: Recently, growing attention has shifted to apolipoprotein A-I (ApoA-I), revealing compelling relationship between low ApoA-I and ischemia risk. Diabetes mellitus (DM) frequently coexists with abnormal ApoA-I levels. However, the association between ApoA-I and ischemia risk under different diabetes statuses in patients undergoing percutaneous coronary intervention (PCI) remains unclear.

Hypothesis: We hypothesized that diabetes status could modify the relationship between ApoA-I levels and ischemia risk in PCI patients.

Methods: This prospective study included consecutive 10724 patients treated with PCI throughout 2013. Patients were categorized into 3 subgroups: DM, pre-DM, and normal group. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE, including all-cause death, myocardial infarction, stroke, and revascularization).

Results: Among 10232 PCI patients finally included, 2139 (20.9%) MACCEs occurred at 5-year follow-up. There was a significant interaction between ApoA-I and diabetes status (P for interaction = 0.044). In the DM group, an L-shaped curve was observed (Figure 1A), and multivariate Cox regression analysis revealed that only the lowest quintile level of ApoA-I exhibited an increased risk of MACCE (hazard ratio [HR], 1.336; 95% CI, 1.101-1.620; P = 0.003) (Figure 1B). However, neither the normal group nor pre-DM groups could observe the association between ApoA-I and MACCE (both P >0.05). Further sensitivity analysis, stratifying ApoA-I into two groups based on median level, also indicated the highest MACCE in those combined with lower ApoA-I levels and DM (Figure 1C).

Conclusions: In a large-scale 5-years follow-up study, we were the first to demonstrate that diabetes status modified the ischemia risk of low ApoA-I levels, highlighting the clinical importance of low ApoA-I levels for risk stratification and focusing on diabetes status in future therapy targeting ApoA-I.