Non-high-density lipoprotein cholesterol predicts nonfatal recurrent myocardial infarction in patients with ST
Ming Gao1, Yang Zheng1, Weihua Zhang1
1The Cardiovascular Center, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China.
Insights
Non-high-density lipoprotein cholesterol is a key predictor of recurrent myocardial infarction after percutaneous coronary intervention. Higher levels significantly increase reinfarction risk in ST-elevation myocardial infarction patients.
Area of Science:
- Cardiology
- Lipidology
- Interventional Cardiology
Background:
- Lipids play a role in atherogenesis, clotting, and fibrinolysis, potentially indicating recurrent myocardial infarction (MI).
- Predictive value of baseline lipid fractions for nonfatal recurrent MI was assessed in ST-elevation MI patients post-primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To determine the predictive value of baseline lipid profiles for nonfatal recurrent myocardial infarction (MI).
- To evaluate lipid fractions as prognostic indicators in ST-elevation MI patients undergoing primary PCI in China.
Main Methods:
- Cox proportional-hazards models analyzed risk factors, including lipid fractions, for nonfatal recurrent MI.
- 2402 consecutive patients undergoing primary PCI for ST-elevation MI were included in the analysis.
Main Results:
- Cumulative incidence of recurrent MI was 5.8% at 3 years post-PCI.
- Principal component analysis identified non-high-density lipoprotein cholesterol (non-HDL-C) as the strongest predictor.
- Adjusted hazard ratios showed non-HDL-C (1.26) was a significant predictor, with the highest quartile associated with a 2.10 odds ratio for reinfarction.
Conclusions:
- Non-high-density lipoprotein cholesterol is a stronger predictor of nonfatal recurrent MI than other lipid factors in ST-elevation MI patients.
- Patients with the highest non-HDL-C levels exhibited the highest reinfarction rates post-PCI.
Background:
Lipids, which are associated with atherogenesis, clotting, and the fibrinolytic pathway, may be important prognostic indicators of recurrent myocardial infarction. The aim of this study was to determine the predictive value of baseline lipid fractions for nonfatal recurrent myocardial infarction in patients with ST segment elevation myocardial infarction 2 years after primary percutaneous coronary intervention in China.
Methods:
Cox proportional-hazards models were used to evaluate the association between potential risk factors, including lipid fractions, and the occurrence of nonfatal recurrent myocardial infarction in 2402 consecutive patients who underwent primary percutaneous coronary intervention for ST segment elevation myocardial infarction.
Results:
The cumulative incidence of recurrent myocardial infarction was 2.7% at 1 year, 3.8% at 2 years, and 5.8% at 3 years after percutaneous coronary intervention. The effects of collinearity of lipids were investigated. In concerning the principal components analysis, composing factor 1 (scoring factors were 0.689 for non-HDL, 0.702 for LDL, 0.182 for HDL) which had eigenvalues of 1.86 and explained 62% of the variability among lipid cholesterols was significantly associated with recurrent MI in the final adjusted analysis of the lipid cholesterols principal components. Non-high-density lipoprotein cholesterol was the strongest independent predictor of nonfatal recurrent myocardial infarction. The adjusted hazards ratios for nonfatal recurrent myocardial infarction were 1.26 (95% confidence interval (CI): 1.05-1.51) for non-high-density lipoprotein cholesterol, 1.17 (95% CI: 0.99-1.39) for low-density lipoprotein and 1.15 (95% CI: 0.95-1.40) for HDL. After adjusting for gender and age, the odds ratio for patients in the highest non-high-density lipoprotein cholesterol quartile was 2.10 (95% CI: 1.19-3.72).
Conclusions:
Non-high-density lipoprotein cholesterol value is a stronger predictor of nonfatal recurrent myocardial infarction than other lipid risk factors in patients with ST segment elevation myocardial infarction. Moreover, the occurrence of reinfarction after percutaneous coronary intervention was highest for patients in the highest non-high-density lipoprotein cholesterol quartile.
Trial Registration:
http://www.chictr.org.cn/edit.aspx?pid=13583&htm=4 , registration number: ChiCTR-EPC-16008199, date of registration:2013.01.01.
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