The Ratio of High‐Density Lipoprotein Cholesterol to Apolipoprotein A‐I Predicts Myocardial Injury Following Elective Percutaneous Coronary Intervention

Background High‐density lipoprotein ( HDL ) has cardioprotective properties. Each HDL particle has a few molecules of apolipoprotein A‐I ( apoA ‐I) and carries various amounts of cholesterol. The ratio of high‐density lipoprotein cholesterol ( HDL ‐C) to apoA ‐I may reflect mean HDL particle size. Hypothesis HDL ‐C/ apoA ‐I ratio may provide more information than HDL ‐C and apoA ‐I in predicting myocardial injury following elective percutaneous coronary intervention ( PCI ). Methods We prospectively enrolled 2529 consecutive patients who underwent elective PCI and assessed the relationships of preprocedural HDL ‐C, apoA ‐I, and their ratio with peak cardiac troponin I ( cTnI ) within 24 hours after PCI . Results Neither HDL ‐C nor apoA ‐I levels showed significant association with postprocedural cTnI elevation, whereas HDL ‐C/ apoA ‐I ratio was associated with postprocedural cTnI elevation above 3 up to 30 × upper limit of normal ( ULN ), with the lowest risk in the middle quintile (all P values for quadratic term were <0.05). Adjusted odds ratios (95% confidence interval) of postprocedural cTnI >3 ×  ULN for quintile 1 to 5 of HDL ‐C/ apoA ‐I ratio were: 1 (reference), 0.81 (0.62‐1.07), 0.57 (0.43‐0.75), 0.65 (0.49‐0.85), and 0.76 (0.58–1.01), respectively, and the adjusted odds ratios of postprocedural cTnI >30 ×  ULN for quintile 1 to 5 of HDL ‐C/ apoA ‐I ratio were: 1 (reference), 0.81 (0.49‐1.361), 0.42 (0.23‐0.77), 0.66 (0.38‐1.14), and 0.82 (0.49‐1.38), respectively. Conclusions There was a U‐shaped association between HDL ‐C/ apoA ‐I ratio and myocardial injury following PCI .