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Zeng RX, Li S, Zhang MZ, Li XL, Zhu CG, Guo YL, Zhang Y, Li JJ. Remnant cholesterol predicts periprocedural myocardial injury following percutaneous coronary intervention in poorly-controlled type 2 diabetes. J Cardiol 2017; 70:113-120. [PMID: 28209463 DOI: 10.1016/j.jjcc.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/26/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Remnant cholesterol (RC) is receiving increasing attention regarding its relation to cardiovascular risk. Whether RC is associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in type 2 diabetes (T2D) is currently unknown. METHODS We prospectively enrolled 1182 consecutive T2D patients who were scheduled for PCI but with baseline normal preprocedural cardiac troponin I (cTnI). Patients were divided according to their glycemic control status: group A [glycated hemoglobin (HbA1c)<7%, n=563] and group B (HbA1c≥7%, n=619). PMI was evaluated by cTnI analysis within 24h. The associations of preprocedural RC and the RC to high-density lipoprotein cholesterol ratio (RC/HDL-C) with PMI were investigated. RESULTS The associations of RC and RC/HDL-C with PMI were observed in group B (both p<0.05) but not in group A (both p>0.05). Patients in group B, a 1-SD increase of RC produced 30% and 32% increased risk for postprocedural cTnI>3× upper limit of normal (ULN) and >5×ULN, respectively. The odds ratios for RC/HDL-C were the highest compared with any cholesterol fractions including total cholesterol (TC)/HDL-C, low density lipoprotein cholesterol (LDL-C)/HDL-C, nonHDL-C/HDL-C, and triglyceride/HDL-C with 1.43 [95% confidence interval (CI): 1.10-1.88] for >3× ULN and 1.49 (95% CI: 1.13-1.97) for >5× ULN. However, no such associations were found in group A. Furthermore, patients with RC >27.46mg/dL (third tertile) [RC≤14.15mg/dL (first tertile) as reference] were associated with a 1.57-fold and 2-fold increased risk for >3× ULN and >5× ULN in group B, respectively. CONCLUSIONS RC and RC/HDL-C might be valuable, independent predictors for PMI in poorly-controlled diabetic patients undergoing PCI.
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Affiliation(s)
- Rui-Xiang Zeng
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min-Zhou Zhang
- Guangdong Provincial Hospital of Chinese Medicine & The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Christensen MK, Huang H, Torp-Pedersen C, Trydal T, Ravkilde J. Incidence and impact on prognosis of peri-procedural myocardial infarction in 2760 elective patients with stable angina pectoris in a historical prospective follow-up study. BMC Cardiovasc Disord 2016; 16:140. [PMID: 27305902 PMCID: PMC4910200 DOI: 10.1186/s12872-016-0293-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical significance of myocardial infarction related to treatment with percutaneous coronary intervention (PCI) has been subject of great discussion. This subject has been studied for many years using different definitions of peri-procedural myocardial infarction and different biomarkers, the results have varied greatly depending on methods and time of the study. This study was to determine the incidence and prognostic significance of elevated cardiac biomarkers after elective PCI in patients with stable angina pectoris using the current cut-off set by the Third Universal Definition of Myocardial Infarction and current biomarkers. METHODS We performed a historical prospective follow-up study of all patients with stable angina pectoris who underwent elective PCI at Aalborg University Hospital, Denmark from January 1(st) 2000 to December 31(st) 2012. We stratified patients according to peak post-PCI troponin T (cTnT) and Creatine Kinase MB mass (CK-MBmass). RESULTS Follow-up for time to all-cause mortality was mean 5.8 years and total 15,891 years and mean 3.7 years and total 10,160 years for the combined endpoint of all-cause mortality and new onset heart failure. During the follow up period 399 of 2760 patients died (14.5 %) and 1095 (39.7 %) suffered the combined endpoint. Post-PCI concentration of cTnT and CK-MBmass was elevated above the defined cut-off in 419 patients (15.2 %) and 113 patients (4.1 %) respectively. There was no statistically significant difference between the groups in stratified analysis of the hazard rates by time regarding all-cause mortality for cTnT nor CK-MBmass. Regarding the combined endpoint the results were ambiguous. The results were unchanged in multivariable analyses that included age and gender. CONCLUSION The incidence of elevated biomarkers after elective PCI in patients with stable angina pectoris using the defined cut-off (>5 x URL) was 15.2 % using cTnT and 4.1 % using CK-MBmass. The independent prognostic value for both cardiac biomarkers of any cut-off showed no statistical significance for all-cause mortality, whereas the combined endpoint (all-cause mortality or new-onset heart failure) were ambiguous in both short- and long-term follow-up.
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Affiliation(s)
| | - Hui Huang
- General Hospital of Ningxia Medical University, Yinchuan, China and Visiting Doctor at Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Torleif Trydal
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Li XL, Guo YL, Zhu CG, Xu RX, Qing P, Wu NQ, Jiang LX, Xu B, Gao RL, Li JJ. Relationship of high-density lipoprotein cholesterol with periprocedural myocardial injury following elective percutaneous coronary intervention in patients with low-density lipoprotein cholesterol below 70 mg/dL. J Am Heart Assoc 2015; 4:e001412. [PMID: 25572484 PMCID: PMC4330066 DOI: 10.1161/jaha.114.001412] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent data showed inconsistent association of high-density lipoprotein cholesterol (HDL-C) with cardiovascular risk in patients with different levels of low-density lipoprotein cholesterol (LDL-C) or intensive statin therapy. This study sought to determine the relationship of HDL-C with periprocedural myocardial injury following elective percutaneous coronary intervention (PCI) across a range of LDL-C levels, especially in patients with LDL-C <70 mg/dL. METHODS AND RESULTS We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who underwent elective PCI. The association between preprocedural HDL-C and periprocedural myocardial injury was evaluated across LDL-C levels, especially in patients with LDL-C <70 mg/dL. The HDL-C level was not predictive of periprocedural myocardial injury across the entire study cohort. However, among patients with LDL-C <70 mg/dL, a 1 mg/dL increase in HDL-C was associated with a 3% reduced risk for postprocedural cTnI above 1×upper limit of normal (ULN) (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.004), a 3% reduced risk for postprocedural cTnI above 3×ULN odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.022), and a 3% reduced risk for postprocedural cTnI above 5×ULN (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.017). The relation between plasma HDL-C level and risk of postprocedural cTnI elevation above 1×ULN, 3×ULN, and 5×ULN was modified by LDL-C level (all P for interaction <0.05). CONCLUSIONS Higher HDL-C levels were associated with reduced risk of periprocedural myocardial injury only in patients with LDL-C <70 mg/dL.
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Affiliation(s)
- Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Ping Qing
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Li-Xin Jiang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Bo Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Run-Lin Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China (X.L.L., Y.L.G., C.G.Z., R.X.X., P.Q., N.Q.W., L.X.J., B.X., R.L.G., J.J.L.)
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Zeng RX, Li XL, Zhang MZ, Guo YL, Zhu CG, Guo LH, Li S, Zhang Y, Li JJ. Non-HDL cholesterol is a better target for predicting periprocedural myocardial injury following percutaneous coronary intervention in type 2 diabetes. Atherosclerosis 2014; 237:536-43. [PMID: 25463086 DOI: 10.1016/j.atherosclerosis.2014.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/18/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Non-HDL cholesterol (non-HDL-C) has recently been recommended as a first target for dyslipidemia management. We previously reported that LDL cholesterol (LDL-C) and non-HDL-C levels were similarly associated with periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) in patients with coronary artery disease. Here we investigated the comparative prognostic value of non-HDL-C and LDL-C for PMI following PCI in type 2 diabetes (T2D). METHODS We prospectively enrolled 1194 consecutive T2D patients with normal preprocedural cTnI undergoing PCI. Patients were divided into the two groups: group A [glycated hemoglobin (HbA1c) < 7%, n = 567] and group B (HbA1c ≥ 7%, n = 627). PMI was evaluated by cTnI analysis within 24 h. The relationship of preprocedural non-HDL-C and LDL-C levels with peak cTnI values after PCI was examined. RESULTS Patients in group B, with higher preprocedural non-HDL-C levels, had higher postprocedural cTnI levels (β = 0.102, P = 0.011). In the multivariable model, a 1-SD increase in non-HDL-C produced a 30% and 33% increased risk of postprocedural cTnI >3 × upper limit of normal (ULN) and >5 × ULN in group B, respectively. However, neither LDL-C nor group A patients were affected. Furthermore, patients with non-HDL-C levels ≥ 130 mg/dl compared with non-HDL-C levels ≤ 100 mg/dl were associated with a 83.3% and 71.7% increased risk of postprocedural cTnI >3 × ULN and >5 × ULN in group B, respectively. CONCLUSIONS In poorly-controlled diabetic patients (HbA1c ≥ 7%) undergoing PCI, non-HDL-C but not LDL-C was independently associated with and increased risk of PMI, and non-HDL-C levels ≥ 130 mg/dl had a worse PMI risk profile compared with non-HDL-C levels <100 mg/dl.
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Affiliation(s)
- Rui-Xiang Zeng
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China
| | - Min-Zhou Zhang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China
| | - Li-Heng Guo
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, Beijing 100037, China.
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Li XL, Li JJ, Guo YL, Zhu CG, Qing P, Wu NQ, Xu B, Gao RL. The ratio of high-density lipoprotein cholesterol to apolipoprotein A-I predicts myocardial injury following elective percutaneous coronary intervention. Clin Cardiol 2014; 37:558-65. [PMID: 25113039 DOI: 10.1002/clc.22308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/21/2014] [Accepted: 05/27/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND High-density lipoprotein (HDL) has cardioprotective properties. Each HDL particle has a few molecules of apolipoprotein A-I (apoA-I) and carries various amounts of cholesterol. The ratio of high-density lipoprotein cholesterol (HDL-C) to apoA-I may reflect mean HDL particle size. HYPOTHESIS HDL-C/apoA-I ratio may provide more information than HDL-C and apoA-I in predicting myocardial injury following elective percutaneous coronary intervention (PCI). METHODS We prospectively enrolled 2529 consecutive patients who underwent elective PCI and assessed the relationships of preprocedural HDL-C, apoA-I, and their ratio with peak cardiac troponin I (cTnI) within 24 hours after PCI. RESULTS Neither HDL-C nor apoA-I levels showed significant association with postprocedural cTnI elevation, whereas HDL-C/apoA-I ratio was associated with postprocedural cTnI elevation above 3 up to 30 × upper limit of normal (ULN), with the lowest risk in the middle quintile (all P values for quadratic term were <0.05). Adjusted odds ratios (95% confidence interval) of postprocedural cTnI >3 × ULN for quintile 1 to 5 of HDL-C/apoA-I ratio were: 1 (reference), 0.81 (0.62-1.07), 0.57 (0.43-0.75), 0.65 (0.49-0.85), and 0.76 (0.58-1.01), respectively, and the adjusted odds ratios of postprocedural cTnI >30 × ULN for quintile 1 to 5 of HDL-C/apoA-I ratio were: 1 (reference), 0.81 (0.49-1.361), 0.42 (0.23-0.77), 0.66 (0.38-1.14), and 0.82 (0.49-1.38), respectively. CONCLUSIONS There was a U-shaped association between HDL-C/apoA-I ratio and myocardial injury following PCI.
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Affiliation(s)
- Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Relationship of glycated hemoglobin levels with myocardial injury following elective percutaneous coronary intervention in patients with type 2 diabetes mellitus. PLoS One 2014; 9:e101719. [PMID: 24988213 PMCID: PMC4079566 DOI: 10.1371/journal.pone.0101719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/11/2014] [Indexed: 12/04/2022] Open
Abstract
Background Glycated hemoglobin (HbA1c) predicts clinical cardiovascular disease or cardiovascular mortality. However, the relationship between HbA1c and myocardial injury following elective percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (DM) has not been investigated. Objectives The study sought to assess the relationship between HbA1c and myocardial injury following elective PCI in patients with type 2 DM. Methods We studied a cohort of consecutive 994 diabetic patients with coronary artery disease (CAD) undergoing elective PCI. Periprocedural myocardial injury was evaluated by analysis of troponin I (cTnI). The association between preprocedural HbA1c levels and the peak values of cTnI within 24 hours after PCI was evaluated. Results Peak postprocedural cTnI >1×upper limit of normal (ULN), >3×ULN and >5×ULN were detected in 543 (54.6%), 337 (33.9%) and 245 (24.6%) respectively. In the multivariate model, higher HbA1c levels were associated with less risk of postprocedural cTnI >1×ULN (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.76–0.95; P = 0.005). There was a trend that higher HbA1c levels were associated with less risk of postprocedural cTnI >3×ULN (OR, 0.90; 95% CI, 0.81–1.02; P = 0.088). HbA1c was not associated with the risk of postprocedural cTnI elevation above 5×ULN (OR, 0.95; 95% CI, 0.84–1.08; P = 0.411). Conclusions The present study provided the first line of evidence that higher preprocedural HbA1c levels were associated with less risk of myocardial injury following elective PCI in diabetic patients.
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Li XL, Li JJ, Guo YL, Zhu CG, Xu RX, Li S, Qing P, Wu NQ, Jiang LX, Xu B, Gao RL. Association of preprocedural low-density lipoprotein cholesterol levels with myocardial injury after elective percutaneous coronary intervention. J Clin Lipidol 2014; 8:423-32. [PMID: 25110224 DOI: 10.1016/j.jacl.2014.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/14/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lower levels of low-density lipoprotein cholesterol (LDL-C) are associated with less cardiovascular risk in patients with coronary artery disease. OBJECTIVES To assess whether lower preprocedural LDL-C levels are associated with less risk of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention (PCI). METHODS We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who successfully underwent elective PCI. The association between preprocedural LDL-C levels and peak cTnI levels within 24 hours after PCI was evaluated. RESULTS Preprocedural LDL-C levels were correlated to postprocedural cTnI levels (r = 0.059, P = .003). In the multivariable model, preprocedural LDL-C levels between 70 and 99 mg/dL were associated with less risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN) (odds ratio [OR]: 0.804; 95% confidence interval [CI]: 0.663-0.975; P = .027) up to 15 × ULN (OR: 0.709; 95% CI: 0.530-0.949; P = .021) compared with preprocedural LDL-C levels ≥100 mg/dL. Moreover, preprocedural LDL-C levels <70 mg/dL were more strongly associated with less risk of postprocedural cTnI elevation above 1 × ULN (OR: 0.736; 95% CI: 0.584-0.927; P = .009) up to 15 × ULN (OR: 0.655; 95% CI: 0.452-0.950; P = .026). CONCLUSIONS Lower preprocedural LDL-C levels were associated with less risk of periprocedural myocardial injury in patients undergoing elective PCI.
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Affiliation(s)
- Xiao-Lin Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Jian-Jun Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China.
| | - Yuan-Lin Guo
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Cheng-Gang Zhu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Rui-Xia Xu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Sha Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Ping Qing
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Na-Qiong Wu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Li-Xin Jiang
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Bo Xu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Run-Lin Gao
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
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