| Objectives Low-density lipoprotein cholesterol (LDL-C) is the primary measure of the atherogenic risk of the apolipoprotein B lipoproteins. Low levels of LDL-C are associated with less cardiovascular events in patients with coronary artery disease (CAD). The strategy of goal-directed LDL-C lowering was recommended by guidelines for secondary prevention of CAD. Percutaneous coronary intervention (PCI) has become an important strategy for patients with both stable and unstable CAD. However, cardiac marker elevation after PCI, also known as PCI-related myocardial infarction or injury, is still common especially with the use of high-sensitivity troponin. The aim of the present study was to assess whether preprocedural LDL-C levels are associated with cardiac biomarker elevation after elective percutaneous coronary intervention (PCI), whether achieving target levels of LDL-C before PCI is associated with decreased risk of peri procedural myocardial injury.Methods We enrolled2529consecutive patients with normal preprocedural cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) who successfully underwent elective PCI. Lipid profile and plasma markers were measured, and demographic characteristics were collected before procedure. PCI-related parameters were recorded during procedure. The cTnI levels were monitored within24hours after procedure. The association between preprocedural LDL-C levels and the peak values of cTnI within24hours after PCI was evaluated.Results Stepwise multivariable analysis revealed that factors independently associated with postprocedural cTnI levels were age, prior myocardial infarction, family history of CAD, LDL-C, NT-proBNP, preprocedural cTnI, number of target vessels, number of type B2/C lesions, number of bifurcation lesions, number of postdilation and number of stents, whereas glycated hemoglobin, hemoglobin and unstable angina were independently inversely associated with postprocedural cTnI levels (all P<0.05). Preprocedural LDL-C levels were significantly correlated to the peak cTnI levels after PCI (r=0.059, P=0.003). After adjusting for other risk factors, each increase of10mg/dl in preprocedural LDL-C levels was associated with increased risk of postprocedural cTnI elevation above1×upper reference limit (URL) by3.7%, increased risk of postprocedural cTnI elevation above3×URL by4.8%, increased risk of postprocedural cTnI elevation above5×URL by4.2%, increased risk of postprocedural cTnI elevation above10×URL by5.1%and increased risk of postprocedural cTnI elevation above20×URL by4.5%. Compared with preprocedural LDL-C levels≥100mg/dl, preprocedural LDL-C levels between70and99mg/dl were associated with less risk of postprocedural cTnI elevation above1×URL (odds ratio [OR]:0.804;95%confidence interval [CI]:0.663to0.975; P=0.027) up to15×URL (OR:0.709;95%CI:0.530to0.949; P=0.021) in the multivariable model. Moreover, preprocedural LDL-C levels<70mg/dl were more strongly associated with less risk of postprocedural cTnI elevation above1×URL (OR:0.736;95%CI:0.584to0.927; P=0.009) to15×URL (OR:0.655;95%CI:0.452to0.950; P=0.026).Conclusions Higher preprocedural LDL-C levels were associated with increased risk of periprocedural myocardial injury in patients undergoing elective PCI. The optimal guideline levels of LDL-C were associated with less risk of periprocedural myocardial injury. Our findings suggest that achieving target levels of LDL-C before PCI may be beneficial to reduce the risk of periprocedural myocardial injury. Objectives The role of high-density lipoprotein cholesterol (HDL-C) in predicting cardiovascular events has been highly controversial. HDL particles each have a few molecules of apolipoprotein A-I (apoA-I) and carry various amounts of cholesterol. HDL-C/apoA-I ratio may reflect HDL particle size. The purpose of this study was to investigate the relationships of preprocedural HDL-C, apoA-I and HDL particle size with myocardial injury following elective percutaneous coronary intervention (PCI). HDL-C may be a risk factor and a potential therapeutic target for considerable residual risk in patients who reached a very low low-density lipoprotein cholesterol (LDL-C) level. We also sought to determine the association of HDL-C with periprocedural myocardial injury following elective PCI across a range of LDL-C levels, especially in patients with LDL-C<70mg/dl.Methods We consecutively enrolled2529patients who underwent elective PCI and assessed the relationships of preprocedural HDL-C, apoA-I and HDL particle size with peak cardiac troponin I (cTnI) within24hours after PCI. HDL particle size was estimated from HDL-C/apoA-I ratio.ResultsNeither HDL-C nor apoA-I levels showed significant association with postprocedural cTnI elevation above1to30xupper limit of normal (ULN). There was a U-shaped association between HDL-C/apoA-I ratio and postprocedural cTnl elevation above3to30xULN with the lowest risk in third quintile (all P values for quadratic term were<0.05). Adjusted odds ratios (95%confidence interval) of postprocedural cTnI>3xULN for quintile1to5of HDL particle size were1(reference),0.81(0.62-1.07),0.57(0.43-0.75),0.65(0.49-0.85), and0.76(0.58-1.01); and adjusted odds ratios of postprocedural cTnI>30xULN for quintile1to5of HDL particle size were1(reference),0.81(0.49-1.361),0.42(0.23-0.77),0.66(0.38-1.14), and0.82(0.49-1.38). Although HDL-C level was not predictive of periprocedural myocardial injury across the entire study cohort, subgroup analysis by LDL-C levels showed that a1mg/dl increase in HDL-C in patients with LDL-C<70mg/dl was associated with a3%reduced risk for postprocedural cTnI above1×upper limit of normal (ULN)(odds ratio [OR]:0.97;95%confidence interval [CI]:0.95-0.99; P=0.004), a3%reduced risk for postprocedural cTnI above3xULN (OR:0.97;95%CI:0.95-0.99; P=0.022), and a3%reduced risk for postprocedural cTnI above5×ULN (OR:0.97;95%CI:0.95-0.99; P=0.017). HDL-C levels were not associated with the risk of periprocedural myocardial injury in in patients with LDL-C≥70mg/dl.Conclusions Neither HDL-C nor apoA-I was associated with postprocedural cTnI elevation, whereas there was a U-shaped association between HDL-C/apoA-I ratio and postprocedural cTnI elevation. And subgroup analysis showed that higher HDL-C levels were associated with reduced risk of periprocedural myocardial injury in patients with LDL-C<70mg/dl. Our findings may suggest that HDL function may be impaired in patients with LDL-C≥70mg/dl, and in patients with extreme high or low HDL-C/apoA-I ratio. Objectives Glycated hemoglobin (HbA1c) is an index of glucose control of diabetes, and predicts clinical cardiovascular disease or cardiovascular mortality. However, the optimal glucose control in diabetic patients with coronary artery disease is still a subject of ongoing controversy. The relationship between glucose control and myocardial injury following elective percutaneous coronary intervention (PCI) in patients with type2diabetes mellitus (DM) has not been investigated. The study sought to assess the relationship between HbA1c and myocardial injury following elective PCI in patients with type2DM.Methods We studied a cohort of consecutive994diabetic patients with coronary artery disease (CAD) undergoing elective PCI. Periprocedural myocardial injury was evaluated by analysis of troponin I (cTnI). The association between preprocedural HbA1c levels and the peak values of cTnI within24hours after PCI was evaluated.Results Peak postprocedural cTnI>lxupper limit of normal (ULN),>3×ULN and>5×ULN were detected in543(54.6%),337(33.9%) and245(24.6%) respectively. In the multivariate model, HbAlc levels were inversely associated with postprocedural cTnI>1×ULN (odds ratio [OR],0.85;95%confidence interval [CI],0.76-0.95; P=0.005). There was a trend that HbA1c levels were inversely associated with postprocedural cTnI>3×ULN (OR,0.90;95%CI,0.81-0.1.02; P=0.088). HbAlc was not associated with postprocedural cTnI elevation above5xULN (OR,0.95;95%CI,0.84-1.08; P=0.411).Conclusions The present study provided the first line of evidence that preprocedural HbA1c levels were inversely associated with minor myocardial injury following elective PCI in diabetic patients, suggesting that less stringent HbAlc goals before procedure may be appropriate for diabetic patients undergoing elective PCI. |
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