Open AccessRelation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST ‐Elevation Myocardial Infarction
Author(s) -
Reindl Martin,
Reinstadler Sebastian Johannes,
Feistritzer HansJosef,
Theurl Markus,
Basic Daniel,
Eigler Christopher,
Holzknecht Magdalena,
Mair Johannes,
Mayr Agnes,
Klug Gert,
Metzler Bernhard
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006957
Subject(s) - medicine , cardiology , myocardial infarction , percutaneous coronary intervention , hazard ratio , mace , odds ratio , cholesterol , heart failure , confidence interval
Background Microvascular injury ( MVI ) after primary percutaneous coronary intervention for ST ‐elevation myocardial infarction ( STEMI ) is a major determinant of adverse clinical outcome. Experimental data indicate an impact of hypercholesterolemia on MVI ; however, there is a lack of clinical studies confirming this relation. We aimed to investigate the association of cholesterol concentrations on admission with MVI visualized by cardiac magnetic resonance imaging and clinical outcome in STEMI patients treated by primary percutaneous coronary intervention. Methods and Results In this prospective, observational study, we included 235 consecutive revascularized STEMI patients. Cholesterol (total cholesterol, low‐density lipoprotein [ LDL ], and high‐density lipoprotein cholesterol) and triglyceride concentrations were determined at presentation. Cardiac magnetic resonance scans were performed 2 (2–4) days after infarction to assess infarct characteristics, including MVI . Clinical end point was the occurrence of major adverse cardiac events ( MACE ) comprising all‐cause mortality, nonfatal reinfarction, and new congestive heart failure. Patients with MVI (n=129; 55%) showed higher levels of total cholesterol (204 [172–226] versus 185 [168–212] mg/dL; P =0.01) and LDL cholesterol (142 [113–166] versus 118 [103–149] mg/dL; P =0.001), whereas high‐density lipoprotein cholesterol and triglycerides did not differ significantly. In multivariable analysis, including all significant clinical and cardiac magnetic resonance determinants of MVI , LDL concentration emerged as an independent predictor of MVI (odds ratio, 1.02 [95% confidence interval, 1.01–1.02]; P =0.002). Furthermore, increased LDL cholesterol (>150 mg/dL) significantly predicted the occurrence of major adverse cardiac events (hazard ratio, 3.09 [95% confidence interval, 1.22–7.87]; P =0.01). Conclusions In STEMI patients undergoing primary percutaneous coronary intervention, baseline LDL cholesterol concentrations were independently associated with MVI , revealing a clinically relevant link between LDL metabolism and MVI in acute STEMI .