Relation of Low-Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST-Elevation Myocardial Infarction.
BACKGROUND
Microvascular injury (MVI) after primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) is a major determinant of adverse clinical outcome. Experimental data indicate an impact of hypercholesterolemia on MVI; however, there is a lack of clinical studies confirming this relation. We aimed to investigate the association of cholesterol concentrations on admission with MVI visualized by cardiac magnetic resonance imaging and clinical outcome in STEMI patients treated by primary percutaneous coronary intervention.


METHODS AND RESULTS
In this prospective, observational study, we included 235 consecutive revascularized STEMI patients. Cholesterol (total cholesterol, low-density lipoprotein [LDL], and high-density lipoprotein cholesterol) and triglyceride concentrations were determined at presentation. Cardiac magnetic resonance scans were performed 2 (2-4) days after infarction to assess infarct characteristics, including MVI. Clinical end point was the occurrence of major adverse cardiac events (MACE) comprising all-cause mortality, nonfatal reinfarction, and new congestive heart failure. Patients with MVI (n=129; 55%) showed higher levels of total cholesterol (204 [172-226] versus 185 [168-212] mg/dL; P=0.01) and LDL cholesterol (142 [113-166] versus 118 [103-149] mg/dL; P=0.001), whereas high-density lipoprotein cholesterol and triglycerides did not differ significantly. In multivariable analysis, including all significant clinical and cardiac magnetic resonance determinants of MVI, LDL concentration emerged as an independent predictor of MVI (odds ratio, 1.02 [95% confidence interval, 1.01-1.02]; P=0.002). Furthermore, increased LDL cholesterol (>150 mg/dL) significantly predicted the occurrence of major adverse cardiac events (hazard ratio, 3.09 [95% confidence interval, 1.22-7.87]; P=0.01).


CONCLUSIONS
In STEMI patients undergoing primary percutaneous coronary intervention, baseline LDL cholesterol concentrations were independently associated with MVI, revealing a clinically relevant link between LDL metabolism and MVI in acute STEMI.
['Reindl|Martin|M|', 'Reinstadler|Sebastian Johannes|SJ|', 'Feistritzer|Hans-Josef|HJ|', 'Theurl|Markus|M|', 'Basic|Daniel|D|', 'Eigler|Christopher|C|', 'Holzknecht|Magdalena|M|', 'Mair|Johannes|J|', 'Mayr|Agnes|A|', 'Klug|Gert|G|', 'Metzler|Bernhard|B|']
D000368:Aged D015415:Biomarkers D008076:Cholesterol, HDL D008078:Cholesterol, LDL D003326:Coronary Circulation D018572:Disease-Free Survival D005260:Female D006333:Heart Failure D006801:Humans D053208:Kaplan-Meier Estimate D019028:Magnetic Resonance Imaging, Cine D008297:Male D008833:Microcirculation D008875:Middle Aged D010343:Patient Admission D062645:Percutaneous Coronary Intervention D016016:Proportional Hazards Models D011446:Prospective Studies D012008:Recurrence D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D013997:Time Factors D016896:Treatment Outcome
magnetic resonance imaging ST‐segment elevation myocardial infarction low‐density lipoprotein cholesterol microvascular dysfunction risk stratification