Early determination of serum lipids and apolipoproteins in acute myocardial infarction: possibility for immediate intervention.

Early identification of elevated cholesterol in patients with acute myocardial infarction (MI) is of interest as secondary prevention can then be initiated when patients are highly motivated. However, since the lipid pattern changes during acute MI, screening for lipid disturbances is often not performed until 6 months later. We prospectively studied lipid and apolipoprotein levels during acute MI and 3 and 6 months later in 123 consecutive acute MI patients, mean age 64 +/- 10 (SD) years, who were admitted within 24 h from onset of symptoms, mean delay 5.5 h. Blood was taken at admission to the Coronary Care Unit (CCU), the first morning in the CCU, at hospital discharge and at 3 and 6 months follow-up. Patients were fasted overnight except at admission, and no specific dietary advice was given. Total serum cholesterol, triglycerides, and apolipoprotein (apo) A-I concentrations did not differ significantly (1-3%) between CCU admission and the 3 and 6 months control. During the subsequent hospital period, lipid concentrations generally decreased and at discharge were 15-25% below those at 6 months follow-up (P less than 0.001). The highest correlations between immediate CCU determination and 6 months follow-up were obtained for cholesterol (r = +0.71) and apo B (r = +0.67). Thus, lipid levels obtained early at CCU admission in acute MI patients are representative of the patient's baseline levels which are in contrast to those registered later during hospital stay. This information could be used to identify patients for early intervention.