The prognostic value of very low admission LDL-cholesterol levels in ST-segment elevation myocardial infarction compared in statin-pretreated and statin-naive patients undergoing primary percutaneous coronary intervention

Oduncu, Vecih; Erkol, Ayhan; Kurt, Mustafa; Tanboğa, İbrahi̇m Hali̇l; Karabay, Can Yücel; Şengül, Cihan; Bulut, Mustafa; Özveren, Olcay; Fotbolcu, Hakan; Akgün, Taylan; Türkyılmaz, Erdem; Kırma, Cevat

doi:10.1016/j.ijcard.2012.01.009

Cited by 23 publications

(13 citation statements)

References 24 publications

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“…4 In contrast, Oduncu et al reported that statin therapy was associated with lower inhospital mortality. 12 Given that the present study population was larger (6,486 vs. 1,808), it has provided further evidence for the efficacy of statin therapy in reducing short-term mortality in AMI patients.…”

Section: Discussionmentioning

confidence: 79%

“…4 Oduncu et al reported that statin-pretreated individuals with STEMI undergoing PCI had lower in-hospital mortality and less frequent development of heart failure regardless of LDL-C on admission. 12 In contrast, some studies found that low LDL-C on admission was associated with increased mortality in ACS patients. 10,11 Considering these inconsistent results, the present study provides further evidence for the beneficial effect of statin therapy on short-term mortality in AMI patients regardless of LDL-C level on admission.…”

Section: Discussionmentioning

confidence: 96%

“…4, 12 Another study, however, did not confirm the efficacy of statin therapy on short-term mortality in ACS patients. 5 The influence of LDL-C on the clinical benefit of statin therapy in the acute phase remains uncertain in ACS patients.…”

mentioning

confidence: 99%

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Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –

Miura

Yamasaki²,

Uemura

et al. 2016

Circ J

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 96%

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Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –

Miura

Yamasaki²,

Uemura

et al. 2016

Circ J

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“…Despite the convincing evidence regarding hypercholesterolemia and risk for the development of STEMI, it is still debated whether different LDL values in patients presenting with acute infarction are associated with different postinfarction clinical outcomes . Interestingly, previous investigations reported even favorable outcomes in patients presenting with hypercholesterolemia, which, however, was mainly attributed to important clinical confounders .…”

Section: Discussionmentioning

confidence: 99%

“…The value of admission cholesterol concentrations for the prediction of hard clinical end points following STEMI is also still a matter of controversy . Because of the lack of CMR data, it is further unclear whether infarct characteristics, particularly MVI, represent potential confounders between cholesterol metabolism and postinfarction clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction

Reindl

Reinstadler

Feistritzer

et al. 2017

JAHA

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BackgroundMicrovascular 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 ResultsIn 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).ConclusionsIn 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.

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Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome

et al. 2017

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Although statin therapy is beneficial in the setting of acute coronary syndrome (ACS), a substantial proportion of patients with ACS still do not receive the guideline-recommended lipid management in contemporary practice. We hypothesize that the low-density lipoprotein cholesterol (LDL-C) level at the time of admission might affect patient management and the subsequent outcome. Nine-hundred and forty-two consecutive patients with ACS who underwent percutaneous coronary intervention were analyzed retrospectively. The study patients were first divided into two groups based on the LDL-C level on admission: group A (n = 267), with LDL-C < 100 mg/dL; and group B (n = 675), with LDL-C ≥ 100 mg/dL. Each group was then further divided into those who were prescribed statins or not at the time of discharge from the hospital. The primary endpoint was all-cause death. In addition, we analyzed the serial changes of LDL-C within 1 year. Patients in group A were significantly older and more likely to have multiple comorbidities compared with group B. The proportion of patients who were prescribed statin at discharge was significantly smaller in group A compared with group B (57.7 vs. 77.3%, p < 0.001). During the median 4-year follow-up, there were 122 incidents of all-cause death. Multivariate Cox proportional hazard analysis revealed that LDL-C < 100 mg/dL on admission [hazard ratio (HR), 1.61; 95% confidence interval (CI), 1.09-2.39; p < 0.05] and prescription of statins at discharge (HR, 0.52; 95% CI, 0.36-0.76; p < 0.001) were associated significantly with all-cause death. Under these conditions, increasing LDL-C levels were documented during follow-up in those patients in group A when no statins were prescribed at discharge (79 ± 15-96 ± 29 mg/dL, p < 0.001), whereas these remained unchanged when statins were prescribed at discharge (79 ± 15-77 ± 22 mg/dL, p = 0.30). These results demonstrate that decreased LDL-C on admission in ACS led to less prescription for statins, which could result in increased death, probably due to underestimation of the baseline LDL-C.

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The prognostic value of very low admission LDL-cholesterol levels in ST-segment elevation myocardial infarction compared in statin-pretreated and statin-naive patients undergoing primary percutaneous coronary intervention

Cited by 23 publications

References 24 publications

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –

Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction

Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome

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The prognostic value of very low admission LDL-cholesterol levels in ST-segment elevation myocardial infarction compared in statin-pretreated and statin-naive patients undergoing primary percutaneous coronary intervention

Cited by 23 publications

References 24 publications

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention – Multicenter Registry From Tokyo CCU Network Database –

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention – Multicenter Registry From Tokyo CCU Network Database –

Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction

Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome

Contact Info

Product

Resources

About

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –

Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention　– Multicenter Registry From Tokyo CCU Network Database –