Relationship of high-density lipoprotein cholesterol with periprocedural myocardial injury following elective percutaneous coronary intervention in patients with low-density lipoprotein cholesterol below 70 mg/dL

Background: recent data showed inconsistent association of high-density lipoprotein cholesterol (hdl-c) with cardiovascular risk in patients with different levels of low-density lipoprotein cholesterol (ldl-c) or intensive statin therapy. this study sought to determine the relationship of hdl-c with periprocedural myocardial injury following elective percutaneous coronary intervention (pci) across a range of ldl-c levels,especially in patients with ldl-c <70 mg/dl.methods and results: we enrolled 2529 consecutive patients with normal preprocedural cardiac troponin i (ctni) who underwent elective pci. the association between preprocedural hdl-c and periprocedural myocardial injury was evaluated across ldl-c levels,especially in patients with ldl-c <70 mg/dl. the hdl-c level was not predictive of periprocedural myocardial injury across the entire study cohort. however,among patients with ldl-c <70 mg/dl,a 1 mg/dl increase in hdl-c was associated with a 3% reduced risk for postprocedural ctni above 1×upper limit of normal (uln) (odds ratio: 0.97; 95% ci: 0.95 to 0.99; p=0.004),a 3% reduced risk for postprocedural ctni above 3×uln odds ratio: 0.97; 95% ci: 0.95 to 0.99; p=0.022),and a 3% reduced risk for postprocedural ctni above 5×uln (odds ratio: 0.97; 95% ci: 0.95 to 0.99; p=0.017). the relation between plasma hdl-c level and risk of postprocedural ctni elevation above 1×uln,3×uln,and 5×uln was modified by ldl-c level (all p for interaction <0.05).conclusions: higher hdl-c levels were associated with reduced risk of periprocedural myocardial injury only in patients with ldl-c <70 mg/dl. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.