title: Relation of admission high-density lipoprotein cholesterol level and in-hospital mortality in patients with acute non-ST segment elevation myocardial infarction (from the National Cardiovascular Data Registry).
abstract: Despite recent therapeutic advances, significant residual risk for in-hospital mortality persists among patients admitted with acute myocardial infarction (MI). Low levels of high-density lipoprotein cholesterol (HDL-C), a known independent predictor of increased cardiovascular events, may be an important modulator of heightened risk after acute MI. We evaluated admission HDL-C levels among 98,276 patients with non-ST elevation myocardial infarction with acute MI from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) program who were enrolled from 490 United States hospitals from January 2007 to December 2010. Clinical characteristics, treatments, atherosclerotic burden, and in-hospital outcomes were analyzed by quartiles of admission HDL-C (Q1: 10 to 30 mg/dl; Q2: 30.1 to 36.9 mg/dl; Q3: 37 to 45 mg/dl; and Q4: 45.1 to 100 mg/dl). Logistic regression was used to explore the relation among HDL-C quartiles, coronary artery disease severity, and in-hospital mortality. Almost half of the patients with acute MI had low admission levels of HDL-C (less than the median 36.9 mg/dl). Such patients were younger, more often men, white, obese, diabetic, smokers, and had higher rates of previous cardiovascular events. After multivariate adjustment, patients with low HDL-C levels had greater extent of severe angiographic multivessel coronary narrowings and higher mortality. Among the 26% of patients in the lowest HDL-C quartile (≤30 mg/dl), there was a 16% greater risk of in-hospital mortality compared with patients in the highest HDL-C quartile (p = 0.012). In conclusion, low levels of HDL-C were common in patients admitted with acute MI and were associated with more extensive angiographic coronary disease. Very low levels of admission HDL-C were observed in one-quarter of patients and associated with significantly higher in-hospital mortality.
authors.affiliation: Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Subroto
authors.initials: S
authors.lastname: Acharjee
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Holmes
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D008076:Cholesterol, HDL / Q000097:blood*; D017023:Coronary Angiography; D003955:Diagnostic Tests, Routine; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D008076:Cholesterol, HDL