Different clinical and coronary angiographic findings according to ratios of total cholesterol to high-density lipoprotein cholesterol during the acute phase of myocardial infarction.
OBJECTIVE
Several pathological studies have shown that a higher ratio of the serum total cholesterol concentration to the high-density lipoprotein cholesterol concentration (TC/HDL-C ratio) is associated with plaque rupture in patients with acute coronary syndromes. We examined the relationship between the serum total cholesterol concentration and the TC/HDL-C ratio, and clinical and angiographic findings in patients with first acute myocardial infarction.


METHODS
Two hundred eighty patients were classified into quartiles according to the TC/HDL-C ratio measured within 24 hr from symptom onset: 70 patients in the first quartile (group L: mean TC/HDL-C ratio, 3.0), 140 in the second and third quartiles (group M: mean TC/HDL-C ratio, 4.6), and 70 in the fourth quartile (group H: mean TC/HDL-C ratio, 7.5).


RESULTS
There were no differences among the three groups with regard to sex, diabetes mellitus or hypertension. Patients in group L were older (66 +/- 9 vs 60 +/- 11, 56 +/- 10 years, p < 0.01) and had a higher incidence of stable angina before acute myocardial infarction (26% vs 14%, 10%, p < 0.05) than in patients groups M and H. Although coronary angiograms revealed no difference in the number of diseased vessels among the three groups, extent index indicating the proportion of each coronary segment that appears angiographically abnormal was lowest in group L (0.7 +/- 0.5), followed by group M (1.3 +/- 0.6), and high- est in group H ( 1.7 +/- 0.6, p < 0.01). The number of segments with calcification and the incidence of calcification in the culprit lesion were higher in group L than in groups M and H.


CONCLUSIONS
Our findings suggest that the clinical presentations and angiographic appearances differ according to the TC/HDL-C ratio in the acute phase of acute myocardial infarction.
Kosuge
Masami
M
Division of Cardiology, Yokohama City University Medical Center, Urafune-cho 4-57, Minami-ku, Yokohama 232-0024.
Kimura
Kazuo
K
Ishikawa
Toshiyuki
T
Shimizu
Tomoaki
T
Sugano
Teruyasu
T
Sumita
Shinichi
S
Hibi
Kiyoshi
K
Takamura
Takeshi
T
Toda
Noritaka
N
Kanna
Masahiko
M
Tsukahara
Kengo
K
Okuda
Jun
J
Tahara
Yoshio
Y
Nozawa
Naoki
N
Furukawa
Eri
E
Umemura
Satoshi
S
D000210:Acute-Phase Reaction; D000368:Aged; D002114:Calcinosis; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging*
D008076:Cholesterol, HDL; D002784:Cholesterol