Relation of admission high-density lipoprotein cholesterol level and in-hospital mortality in patients with acute non-st segment elevation myocardial infarction (from the National Cardiovascular Data Registry)

Subroto Acharjee, Matthew T. Roe, Ezra A Amsterdam, Dajuanicia N. Holmes, William E. Boden

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1057-1062
Number of pages6
JournalAmerican Journal of Cardiology
Volume112
Issue number8
DOIs
StatePublished - Oct 15 2013

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Hospital Mortality
HDL Cholesterol
Registries
Myocardial Infarction
LDL Cholesterol
State Hospitals
Coronary Disease
Coronary Artery Disease
Logistic Models
Guidelines
Mortality
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of admission high-density lipoprotein cholesterol level and in-hospital mortality in patients with acute non-st segment elevation myocardial infarction (from the National Cardiovascular Data Registry). / Acharjee, Subroto; Roe, Matthew T.; Amsterdam, Ezra A; Holmes, Dajuanicia N.; Boden, William E.

In: American Journal of Cardiology, Vol. 112, No. 8, 15.10.2013, p. 1057-1062.

Research output: Contribution to journalArticle

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abstract = "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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