Objective TO evaluate the correlation between acute lipids level and on-statins treatment lipids and 1 year major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, ischaemic stroke, and recurrent myocardial infarction in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Methods Based on the LDL-C level within 24 h after admission, consecutive 624 patients with STEMI undergoing primary PCI were classified into the normal range of LDL-C<3.37 mmol·l−1 (n=380), the critical range of LDL-C 3.37∼4.14 mmol·l−1 (n=159) or the elevated range of LDL-C>4.14 mmol·l−1 (n=85). Of these 624 patients, serum lipids levels of 335 patients after statins treatment for 4 weeks underwent follow-up in outpatient settings. Based on the results of follow-up, these 335 patients were divided into the targeted group (LDL-C<1.81 mmol·l−1, n=77) or the non-targeted group (LDL-C≥1.81 mmol·l−1, n=258). The end point was 1 year MACCE.
Results When compared between different lipid ranges (the normal, the critical and the elevated) of patients, the acute lipid level was not associated with the end points of cardiac death, ischaemic stroke, recurrent myocardial infarction, and MACCE (p=0.871, 0.568, 0.978, 0.587). After 4 weeks statins treatment, the LDL-C level achieved the goal in 77 patients (23.0%). The primary end point occurred in 1.3% of patients treated with LDL-C<1.81 mmol·l−1 group and in 7.4% in LDL-C≥1.81 mmol·l−1 group (p=0.034). Logistic regression analysis showed a significant relationship between acute triglyceride (TG) level and ischaemic stroke (OR, 1.226; 95% CI 1.068 to 1.407; p=0.004), and between LDL-C level after stain therapy and MACCE (OR, 1.788; 95% CI 1.091 to 5.233; p=0.039). Smoking history (OR, 0.136; 95% CI 0.016 to 1.115; p=0.036) and higher SYNTAX score (OR, 1.544; 95% CI 5.387 to 33.522; p=0.018) were predictors of 1 year MACCE in the patients with STEMI undergoing primary PCI.
Conclusions 1 year MACCE follow-up investigation in the patients with STEMI undergoing primary PCI suggested high on-treatment LDL-C level was a high risk of increased MACCE although acute lipid level was not associated with MACCE. This finding supports the concept that achieving low LDL-C levels is an important therapeutic parameter in statins-treated patients following STEMI and PCI.
- myocardial infarction
- percutaneous coronary intervention