Despite recent therapeutic advances, significant residual risk for in-hospital mortality
persists among patients admitted with acute myocardial infarction (MI). Low levels
of high-density lipoprotein cholesterol (HDL-C), a known independent predictor of
increased cardiovascular events, may be an important modulator of heightened risk
after acute MI. We evaluated admission HDL-C levels among 98,276 patients with non-ST
elevation myocardial infarction with acute MI from the Acute Coronary Treatment and
Intervention Outcomes Network Registry–Get With the Guidelines (ACTION Registry–GWTG)
program who were enrolled from 490 United States hospitals from January 2007 to December
2010. Clinical characteristics, treatments, atherosclerotic burden, and in-hospital
outcomes were analyzed by quartiles of admission HDL-C (Q1: 10 to 30 mg/dl; Q2: 30.1
to 36.9 mg/dl; Q3: 37 to 45 mg/dl; and Q4: 45.1 to 100 mg/dl). Logistic regression
was used to explore the relation among HDL-C quartiles, coronary artery disease severity,
and in-hospital mortality. Almost half of the patients with acute MI had low admission
levels of HDL-C (less than the median 36.9 mg/dl). Such patients were younger, more
often men, white, obese, diabetic, smokers, and had higher rates of previous cardiovascular
events. After multivariate adjustment, patients with low HDL-C levels had greater
extent of severe angiographic multivessel coronary narrowings and higher mortality.
Among the 26% of patients in the lowest HDL-C quartile (≤30 mg/dl), there was a 16%
greater risk of in-hospital mortality compared with patients in the highest HDL-C
quartile (p = 0.012). In conclusion, low levels of HDL-C were common in patients admitted
with acute MI and were associated with more extensive angiographic coronary disease.
Very low levels of admission HDL-C were observed in one-quarter of patients and associated
with significantly higher in-hospital mortality.
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Article info
Publication history
Published online: July 29, 2013
Accepted:
May 25,
2013
Received in revised form:
May 25,
2013
Received:
March 8,
2013
Footnotes
This research was supported by the National Cardiovascular Data Registry of the American College of Cardiology Foundation.
See page 1061 for disclosure information.
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Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
