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.
BACKGROUND
Some recent trials reported that, low admission low-density lipoprotein-cholesterol (LDL-C) levels were associated with increased mortality in patients with acute coronary syndromes. We aimed to compare the effect of very low admission LDL-C levels on prognosis in statin-pretreated and statin-naive patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty.


METHODS
The study population consisted of 1808 patients with acute STEMIs who underwent primary angioplasty. The patients were categorized into four groups as: statin-pretreated/LDL-C<70 mg/dl (n=128), statin-pretreated/LDL-C ≥ 70 mg/dl (n=290), statin-naive/LDL-C <70 mg/dl (n=146), statin-naive/LDL-C ≥ 70 mg/dl (n=1244). The median follow-up was 40 months.


RESULTS
The incidences of diabetes mellitus, hypertension, renal insufficiency, anemia, cardiogenic shock on presentation and the mean age were significantly higher in the statin-naive/LDL-C < 70 mg/dl group. In-hospital (2.3% vs 2.4% vs 12.3% vs 3.9%, respectively p<0.001) and long-term mortalities (6.3% vs 7.3% vs 25.9% vs 11.3% respectively, p<0.001) were significantly lower in the "statin-pretreated/LDL-C<70" group. Statin pretreatment was independently predicting lower long-term mortality irrespective of LDL-C level [for the subgroup with LDL-C < 70 mg/dl, Hazard Ratio (HR) 0.24, 95% CI 0.10-0.59, p=0.013; for the subgroup with LDL-C ≥ 70 mg/dl, HR 0.31, 95% CI 0.14-0.83, p=0.022]. LDL-C levels on admission had no independent predictive role on long-term mortality.


CONCLUSIONS
Statin induced low LDL-C levels on admission are associated with better short- and long-term outcomes in patients with STEMI and independently predict lower long-term mortality. However, spontaneously low admission LDL-C levels were associated with increased short- and long-term mortalities.
ayhanerkol@yahoo.com
Vecih
V
Oduncu
Ayhan
A
Erkol
Mustafa
M
Kurt
Ibrahim Halil
IH
Tanboğa
Can Yücel
CY
Karabay
Cihan
C
Şengül
Mustafa
M
Bulut
Olcay
O
Özveren
Hakan
H
Fotbolcu
Taylan
T
Akgün
Erdem
E
Türkyilmaz
Cevat
C
Kırma
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D010343:Patient Admission / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors