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

Autor: Sebastian Johannes Reinstadler, Johannes Mair, Markus Theurl, Hans-Josef Feistritzer, Martin Reindl, Daniel Basic, Magdalena Holzknecht, Agnes Mayr, Bernhard Metzler, Gert Klug, Christopher Eigler
Rok vydání: 2017
Předmět:
Male
Time Factors
microvascular dysfunction
medicine.medical_treatment
Magnetic Resonance Imaging (MRI)
Myocardial Infarction
risk stratification
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Patient Admission
0302 clinical medicine
Recurrence
Risk Factors
Coronary Heart Disease
magnetic resonance imaging
Prospective Studies
030212 general & internal medicine
Myocardial infarction
Prospective cohort study
Original Research
Lipids and Cholesterol
medicine.diagnostic_test
low‐density lipoprotein cholesterol
Middle Aged
Treatment Outcome
medicine.anatomical_structure
Cardiology
lipids (amino acids
peptides
and proteins)
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Magnetic Resonance Imaging
Cine
Disease-Free Survival
Microcirculation
03 medical and health sciences
Coronary circulation
Percutaneous Coronary Intervention
Coronary Circulation
Internal medicine
ST‐segment elevation myocardial infarction
medicine
Humans
Aged
Proportional Hazards Models
Heart Failure
Proportional hazards model
business.industry
Cholesterol
HDL
Percutaneous coronary intervention
Magnetic resonance imaging
Cholesterol
LDL
medicine.disease
Heart failure
ST Elevation Myocardial Infarction
business
Biomarkers
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.117.006957
Popis: 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 .
Databáze: OpenAIRE
Externí odkaz: