Relationship of High‐Density Lipoprotein Cholesterol With Periprocedural Myocardial Injury Following Elective Percutaneous Coronary Intervention in Patients With Low‐Density Lipoprotein Cholesterol Below 70 mg/dL

Background Recent data showed inconsistent association of high‐density lipoprotein cholesterol ( HDL ‐C) with cardiovascular risk in patients with different levels of low‐density lipoprotein cholesterol ( LDL ‐C) or intensive statin therapy. This study sought to determine the relationship of HDL ‐C with periprocedural myocardial injury following elective percutaneous coronary intervention ( PCI ) across a range of LDL ‐C levels, especially in patients with LDL ‐C <70 mg/ dL . Methods and Results We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I ( cTnI ) who underwent elective PCI . The association between preprocedural HDL ‐C and periprocedural myocardial injury was evaluated across LDL ‐C levels, especially in patients with LDL ‐C <70 mg/ dL . The HDL ‐C level was not predictive of periprocedural myocardial injury across the entire study cohort. However, among patients with LDL ‐C <70 mg/ dL , a 1 mg/ dL increase in HDL ‐C was associated with a 3% reduced risk for postprocedural cTnI above 1×upper limit of normal ( ULN ) (odds ratio: 0.97; 95% CI : 0.95 to 0.99; P =0.004), a 3% reduced risk for postprocedural cTnI above 3× ULN odds ratio: 0.97; 95% CI : 0.95 to 0.99; P =0.022), and a 3% reduced risk for postprocedural cTnI above 5× ULN (odds ratio: 0.97; 95% CI : 0.95 to 0.99; P =0.017). The relation between plasma HDL ‐C level and risk of postprocedural cTnI elevation above 1× ULN , 3× ULN , and 5× ULN was modified by LDL ‐C level (all P for interaction <0.05). Conclusions Higher HDL ‐C levels were associated with reduced risk of periprocedural myocardial injury only in patients with LDL ‐C <70 mg/ dL .