Impact of low level of high-density lipoprotein-cholesterol sampled in overnight fasting state on the clinical outcomes in patients with acute myocardial infarction (difference between ST-segment and non-ST-segment-elevation myocardial infarction)

Title
Impact of low level of high-density lipoprotein-cholesterol sampled in overnight fasting state on the clinical outcomes in patients with acute myocardial infarction (difference between ST-segment and non-ST-segment-elevation myocardial infarction)
Author(s)
김영조지미선[지미선]정명호[정명호]안영근[안영근]채승철[채승철]홍택종[홍택종]성인환[성인환]채재근[채재근]김종진[김종진]조명찬[조명찬]
Keywords
PERCUTANEOUS CORONARY INTERVENTION; DRUG-ELUTING STENTS; LONG-TERM MORTALITY; LDL CHOLESTEROL; THERAPY; RUPTURE; ANGIOGENESIS; PRETREATMENT; REGISTRY; EVENTS
Issue Date
201501
Publisher
ELSEVIER SCIENCE BV
Citation
JOURNAL OF CARDIOLOGY, v.65, no.1-2, pp.63 - 70
Abstract
Background: Despite good treatment, there are residual risks in acute myocardial infarction (AMI) patients, and low level of high-density lipoprotein-cholesterol (HDL) has drawn attention as a possible cause. However, the impact of low HDL on ST-segment-elevation myocardial infarction (STEMI) compared with non-ST-segment-elevation myocardial infarction (NSTEMI) is not clear. Our aim was to evaluate the impact of low HDL on clinical outcomes in patients with STEMI or NSTEMI. Methods: We included 9270 AMI patients undergoing successful percutaneous coronary intervention. They were grouped into STEMI and NSTEMI, and subdivided into two groups according to HDL level sampled in overnight fasting state. Primary end point was in-hospital death. Secondary end point was a composite of major adverse cardiac events (MACE) in hospital survivors during one-year follow-up. Results: In the STEMI population, low HDL group showed significantly higher in-hospital death rate [4.6% vs. 1.4%, hazard ratio (HR): 2.380, 95% confidence interval (CI): 1.143-4.956, p = 0.020] than normal HDL group. In NSTEMI population, there was no significant difference between two groups (1.8% vs. 0.9%, HR: 1.231, 95% CI: 0.649-2.335, p = 0.525), but in subgroup analysis, very low HDL subgroup showed higher in-hospital mortality rate compared with normal HDL group (4.0% vs. 0.9%, respectively, p = 0.009). In 12-month MACE rates, there was no significant difference between two groups in both populations. Conclusions: Low HDL was associated with significantly higher risk of in-hospital mortality in STEMI patients, but not in NSTEMI patients. Thus, more aggressive treatment should be considered in STEMI patients with low HDL. (C) 2014 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.
URI
http://hdl.handle.net/YU.REPOSITORY/33678http://dx.doi.org/10.1016/j.jjcc.2014.04.002
ISSN
0914-5087
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의과대학 > 내과학교실 > Articles
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