Elevated high-density lipoprotein cholesterol improves long-term outcome in patients undergoing elective percutaneous coronary intervention
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Percutaneous coronary intervention (PCI)-related myocardial infarction (PMI), defined as an elevation of cardiac troponin I (cTn-I) >3 x upper normal limit after PCI, is associated with a negative prognosis. The aim of the study was to investigate whether high-density lipoprotein cholesterol (HDL-C) had an effect on PMI and its prognosis. To this end, preprocedural HDL-C levels and post-procedural peak cTn-I were assessed in 350 patients undergoing PCI. Data analysis revealed that patients with PMI presented with lower HDL-C levels than those without PMI. Moreover, preprocedural HDL-C levels were inversely related to the occurrence of PMI and to acute myocardial infarction (AMI) during follow-up, the occurrence of PMI being associated with an elevated hazard ratio of AMI. Low-risk levels of preprocedural HDL-C had no influence on the negative outcome effects of PMI and reduction of AMI-free survival. Such protective effects of preprocedural HDL-C may impact on plaque structure and/or myocardium. In conclusion, small increases in HDL-C in patients undergoing elective PCI convert into a substantial reduction of risk for PMI, an acute procedural event associated with poorer long-term cardiovascular prognosis and survival.
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