European Heart Journal Advance Access originally published online on May 27, 2009
European Heart Journal 2009 30(15):1894-1902; doi:10.1093/eurheartj/ehp183
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High high-density lipoprotein-cholesterol reduces risk and extent of percutaneous coronary intervention-related myocardial infarction and improves long-term outcome in patients undergoing elective percutaneous coronary intervention
ehriban Yün1
1 Clinic of Cardiology, West German Heart Center, University Hospital Essen, Essen, Germany
2 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
3 Institut of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
4 Institute of Pathophysiology, Center of Internal Medicine, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
Received 11 August 2008; revised 30 March 2009; accepted 24 April 2009; online publish-ahead-of-print 27 May 2009.
* Corresponding author. Tel: +49 201 723 4414, Fax: +49 201 823 4413, Email: bodo.levkau{at}uni-due.de
Aims: The study tested whether high-density lipoprotein-cholesterol (HDL-C) has an effect on percutaneous coronary intervention (PCI)-induced myocardial infarction and its prognosis. Elevation of cardiac troponin I (cTnI) > 3x upper normal limit after PCI is defined as PCI-related myocardial infarction (PMI) and is associated with a negative prognosis. No data exist on the relationship of HDL-C to PMI and PMI-related outcome.
Methods and results: Pre-procedural HDL-C levels and post-procedural peak cTnI levels were collected in 350 patients undergoing PCI. Data were analysed for PMI and for acute myocardial infarction (AMI) during follow-up. Patients with PMI (n = 115) had lower HDL-C levels than patients without PMI [n = 235; 1.17 mmol/L (0.75–2.51) vs. 1.27 mmol/L (0.70–2.87), P < 0.001]. Pre-procedural HDL-C levels were inversely related to the occurrence of PMI [odds ratio for PMI: 0.884, 95% CI: 0.80, 0.98; P = 0.02 for an HDL-C-increment of 5 mg/dL (0.13 mmol/L)] and to AMI during follow-up [hazard ratio (HR): 0.697, 95% CI: 0.54, 0.90; P = 0.005]. The occurrence of PMI was associated with an elevated HR for AMI (4.702, 95% CI: 1.79, 12.37; P = 0.002). Low-risk levels of pre-procedural HDL-C [men 
40 mg/dL (1.03 mmol/L), women 45 mg/dL (1.16 mmol/L)] did not influence the negative effects of PMI on outcome (HR: 5.510, 95% CI: 1.43, 21.31; P = 0.013) and reduction of AMI-free survival [mean AMI-free survival time with PMI: 1167.5 days (95% CI: 1098.27, 1236.67) vs. 1240.7 days (95% CI: 1220.94, 1290.49) without PMI; log-rank P = 0.005].
Conclusion: Small increases in HDL-C in patients undergoing elective PCI convert into a substantial reduction of risk for PMI, which has adverse effects on the long-term prognosis. Patients with PMI are at a high risk for AMI at any HDL-C level and therefore should receive particular monitoring by the treating physician over a long period after PCI.
Key Words: High-density lipoprotein-cholesterol • Coronary artery disease • PCI-related myocardial infarction • Prognosis
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