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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Plasma LDL-Cholesterol Level at Admission is Independently Associated with Infarct Size in Patients with ST-Segment
Mathijs C Bodde1, Maaike P J Hermans2, Ron Wolterbeek3
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. m.c.bodde@lumc.nl.
Insights
Elevated low-density lipoprotein-cholesterol (LDL-c) is linked to larger heart damage in ST-segment elevation myocardial infarction (STEMI) patients. This finding highlights LDL-c as a significant predictor of infarct size following primary percutaneous coronary intervention (pPCI).
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Hypercholesterolemia is a known risk factor for atherosclerosis and myocardial infarction (MI).
- Elevated LDL-c may influence the extent of myocardial damage post-MI.
- Understanding predictors of infarct size is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between baseline low-density lipoprotein-cholesterol (LDL-c) levels and infarct size.
- To evaluate LDL-c as a predictor of myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients.
- To assess the relationship in patients undergoing primary percutaneous coronary intervention (pPCI).
Main Methods:
- Included 2248 patients with STEMI treated with pPCI between 2004 and 2014.
- Excluded patients with out-of-hospital cardiac arrest, delayed treatment (>10h), or incomplete reperfusion.
- Estimated infarct size using peak creatine kinase (CK) levels during admission.
Main Results:
- Baseline LDL-c level was independently associated with higher peak CK levels (p < 0.001).
- Factors like culprit vessel (LAD), initial TIMI flow, male gender, and treatment delay also correlated with infarct size.
- Prior aspirin therapy was associated with lower peak CK levels (p = 0.050).
Conclusions:
- Elevated baseline LDL-c is an independent predictor of augmented infarct size in STEMI patients.
- LDL-c should be considered alongside established predictors for assessing myocardial damage.
- These findings emphasize the importance of lipid management in STEMI care.
Introduction:
Hypercholesterolemia is a well-known risk factor for developing atherosclerosis and subsequently for the risk of a myocardial infarction (MI). Moreover, it might also be related to the extent of damaged myocardium in the event of a MI. The aim of this study was to evaluate the association of baseline low density lipoprotein-cholesterol (LDL-c) level with infarct size in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneously coronary intervention (pPCI).
Methods:
Baseline blood samples were obtained from all patients admitted between 2004 and 2014 with STEMI who underwent pPCI. Patients were excluded in case of out of hospital cardiac arrest, treatment delay of at least 10 h or no complete reperfusion after pPCI in the culprit vessel. Peak creatine kinase (CK) level was used for infarct size estimation, defined as the maximal value during admission.
Results:
A total of 2248 patients were included in this study (mean age 61.8 ± 12.2 years; 25.0% female). Mean LDL-c level was 3.6 ± 1.1 mmol/L and median peak CK level was 1275 U/L (IQR 564-2590 U/L). Baseline LDL-c level [β = 0.041; (95% CI 0.019-0.062); p < 0.001] was independently associated with peak CK level. Furthermore, left anterior descending artery as culprit vessel, initial TIMI 0-1 flow in the culprit vessel, male gender, and treatment delay were also correlated with high peak CK level (p < 0.05). Prior aspirin therapy was associated with lower peak CK level [β = - 0.073 (95% CI - 0.146 to 0.000), p = 0.050].
Conclusion:
This study demonstrates that besides the more established predictors of infarct size, elevated LDL-c is associated with augmented infarct size in patients with STEMI treated with pPCI.
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