Mi Seon Ji1, Myung Ho Jeong2, Young Keun Ahn1, Young Jo Kim3, Shung Chull Chae4, Taek Jong Hong5, In Whan Seong6, Jei Keon Chae7, Chong Jin Kim8, Myeong Chan Cho9, Seung-Woon Rha10, Jang Ho Bae11, Ki Bae Seung12, Seung Jung Park13. 1. Chonnam National University Hospital, Gwangju, Republic of Korea. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 3. Yeungnam University Hospital, Daegu, Republic of Korea. 4. Kyungpuk National University Hospital, Daegu, Republic of Korea. 5. Busan National University Hospital, Busan, Republic of Korea. 6. Chungnam National University Hospital, Daejon, Republic of Korea. 7. Chunbuk National University Hospital, Jeonju, Republic of Korea. 8. KyungHee University Hospital, Seoul, Republic of Korea. 9. Chungbuk National University Hospital, Cheongju, Republic of Korea. 10. Korea University Guro Hospital, Seoul, Republic of Korea. 11. Konyang University, Daejon, Republic of Korea. 12. Catholic University Hospital, Seoul, Republic of Korea. 13. Asan Medical Center, Seoul, Republic of Korea.
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.
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.
Authors: Jin Sup Park; Kwang Soo Cha; Hye Won Lee; Jun-Hyok Oh; Jung Hyun Choi; Han Cheol Lee; Taek Jong Hong; Myung Ho Jeong; Shung Chull Chae; Young Jo Kim Journal: Cardiol J Date: 2018-03-07 Impact factor: 2.737
Authors: Péter Koncsos; Péter Fülöp; Imre Juhász; Klára Bíró; László Márk; Gábor Simonyi; György Paragh Journal: Wien Klin Wochenschr Date: 2016-07-05 Impact factor: 1.704