LDL Cholesterol and 1-Year Mortality Rate after Acute ST-
Elevation Myocardial Infarction
Osit Bambat MD 1 , Wasan Udayachalerm MD 1 ,
Wacin Buddhari MD 1 ,Jakarpun Chaipromprasit MD 1 , Vorarit Lertsuwunseri MD 1 ,
Siriporn Athisakul MD 1 , Suphot Srimahachota MD 1
Affiliation : 1 Cardiac Center and Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Dyslipidemia is one of the risk factor of coronary artery disease but there have been reports showing paradoxical
effect of LDL cholesterol (LDL-C) level which lower LDL-C level at the time of diagnosis of patients with acute coronary syndrome
was associated with higher 1-year mortality. However, this relationship has not been established in Thai patients.
Objective : To evaluate LDL-C and 1-year all-cause mortality rate after acute ST-elevation myocardial infarction (STEMI) in Thailand.
Materials and Methods : The present study was a retrospective study of 1,542 consecutive patients with STEMI from 1999 to 2015 whom underwent percutaneous coronary intervention (PCI) either primary PCI or rescue PCI at a tertiary care hospital in Thailand. Patients were classified into 4 groups according to their initial LDL-C level: <70 (group 1), 70-99 (group 2), 100-129 (group 3) and ≥ 130 mg/dl (group 4). The primary end point was a 1-year all-cause mortality rate. T-test, Chi-square and survival time analysis were used to analyze.
Results : The rates of 1-year all-cause mortality were 23.0%, 21.2%, 12.3% and 9.2% in group 1, group 2, group 3 and group 4, respectively. Comparing with group 4, the hazard ratio (HR) was 2.72 (95 % confidence interval [CI] 1.62-4.57; P <0.001) for group 1, HR 2.45 (95% CI 1.64-3.66; p <0.001) for group 2 and HR 1.35 (95% CI 0.89-2.06; p =0.153) for group 3. In multivariate analysis, the predictors of 1-year all-cause mortality were Killip class IV (HR 2.40, 95% CI 1.78-3.25; p <0.001), cardiopulmonary resuscitation (HR 2.25, CI 1.64-3.09; p <0.001), left ventricular ejection fraction ≤40% (HR 2.07, 95% CI 1.57-2.72; p <0.001), culprit lesion at left main (HR 1.78, 95% CI 1.13-2.81; p =0.024), creatinine >1.5 mg/dl (HR 1.77, 95% CI 1.32-2.38; p <0.001), but not the LDL-C level ( p =0.732)
Conclusion : In this single center experience, lower LDL-C level at time of diagnosis of STEMI was associated with higher 1-year all- cause mortality but the effect was not shown after multivariate analysis. This represent LDL-C was not the risk factor to predict 1-year all-cause mortality in STEMI but there were other factors that associated with the outcome. LDL-C was independent risk marker.
Keywords : LDL cholesterol, STEMI, 1-year mortality rate
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