Association of preprocedural low-density lipoprotein cholesterol levels with myocardial injury after elective percutaneous coronary intervention

►First study assessed the relation of LDL-C with myocardial injury related to PCI.►Low LDL-C levels were associated with less risk of myocardial injury following PCI.►A guideline LDL-C level of <100 mg/dl related to less myocardial injury after PCI.►An optimal LDL-C level of <70 mg/dl strongly related to less myocardial injury.►Unstable angina was associated with less risk of myocardial injury following PCI.

BackgroundLower levels of low-density lipoprotein cholesterol (LDL-C) are associated with less cardiovascular risk in patients with coronary artery disease.ObjectivesTo assess whether lower preprocedural LDL-C levels are associated with less risk of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention (PCI).MethodsWe enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who successfully underwent elective PCI. The association between preprocedural LDL-C levels and peak cTnI levels within 24 hours after PCI was evaluated.ResultsPreprocedural LDL-C levels were correlated to postprocedural cTnI levels (r = 0.059, P = .003). In the multivariable model, preprocedural LDL-C levels between 70 and 99 mg/dL were associated with less risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN) (odds ratio [OR]: 0.804; 95% confidence interval [CI]: 0.663-0.975; P = .027) up to 15 × ULN (OR: 0.709; 95% CI: 0.530-0.949; P = .021) compared with preprocedural LDL-C levels ≥100 mg/dL. Moreover, preprocedural LDL-C levels <70 mg/dL were more strongly associated with less risk of postprocedural cTnI elevation above 1 × ULN (OR: 0.736; 95% CI: 0.584-0.927; P = .009) up to 15 × ULN (OR: 0.655; 95% CI: 0.452-0.950; P = .026).ConclusionsLower preprocedural LDL-C levels were associated with less risk of periprocedural myocardial injury in patients undergoing elective PCI.