Background:
High-density lipoprotein cholesterol (HDLc) is known to have protective cardiovascular effects. Elevated triglycerides (TRI) are often targeted with therapeutic agents. This study aimed to investigate the effects of TRI in the presence of high and low levels of HDLc on clinical outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI).
Methods:
We analyzed a series of 4391 patients who presented for elective contemporary PCI since 2003 and have completed 1-year clinical follow up. The study cohort comprised of 4 subgroups: high TRI with high HDLc, high TRI with low HDLc, normal TRI with high HDLc, and normal TRI with low HDLc. High TRI was defined as ≥ 200 mg/dl, normal TRI as < 200 mg/dl, high HDLc was defined as ≥ 40mg/dl for males and ≥ 45mg/dl for females, and low HDLc as < 40mg/dl for males and < 45mg/dl for females. The assessed endpoints, death, Q-wave myocardial infarction (Q wave MI), target vessel revascularization (TVR), and a composite of major adverse cardiac events (MACE) were then compared between groups.
Results
Approximately 98.1% of the overall population is on statin therapy. As expected, patients with high HDLc have significantly better outcomes as compared to those with low HDLc and normal TRI; however, the high TRI low HDLc group demonstrated similar outcomes to patients with high HDLc and normal TRI. Additionally, among the group with high TRI, there were no significant differences in 1-year MACE outcomes between tertiles of non-HDL cholesterol. (Table
)
Conclusion:
In patients undergoing PCI with normal triglycerides low HDLc was associated with increased MACE and death at 1 year when compared to high HDLc patients. In contrast, a similar incidence of death and MACE was observed in hypertriglycer-idemic patients with low HDLc and high HDLc levels. Therapies targeted to elevate HDLc among patients with normal TRI may play a critical role in the prevention of recurrent cardiac events post PCI.
Table:
1 Year Outcomes
The Ratio of High-Density Lipoprotein Cholesterol to Apolipoprotein A-I Predicts Myocardial Injury Following Elective Percutaneous Coronary Intervention