Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction
Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infar...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.025958 |
| _version_ | 1811261005162872832 |
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| author | Kyung Hoon Cho Min Chul Kim Eun Ho Choo Ik Jun Choi Su Nam Lee Mahn‐Won Park Chul Soo Park Hee‐Yeol Kim Chan Joon Kim Doo Sun Sim Ju Han Kim Young Joon Hong Myung Ho Jeong Kiyuk Chang Youngkeun Ahn |
| author_facet | Kyung Hoon Cho Min Chul Kim Eun Ho Choo Ik Jun Choi Su Nam Lee Mahn‐Won Park Chul Soo Park Hee‐Yeol Kim Chan Joon Kim Doo Sun Sim Ju Han Kim Young Joon Hong Myung Ho Jeong Kiyuk Chang Youngkeun Ahn |
| author_sort | Kyung Hoon Cho |
| collection | DOAJ |
| description | Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (<70, 70–99, and ≥100 mg/dL), as LDL‐C levels decreased, clinical outcomes worsened (237/3759 [6.3%] in LDL‐C ≥100 mg/dL versus 123/1291 [9.5%] in LDL‐C 70–99 mg/dL versus 86/482 [17.8%] in LDL‐C <70 mg/dL for cardiovascular death; P‐trend<0.001; and 417/3759 [11.1%] in LDL‐C ≥100 mg/dL versus 172/1291 [13.3%] in LDL‐C 70–99 mg/dL versus 106/482 [22.2%] in LDL‐C <70 mg/dL for 3‐point major adverse cardiovascular event; P‐trend<0.001). In a Cox time‐to‐event multivariable model with LDL‐C levels ≥100 mg/dL as the reference, the baseline LDL‐C level <70 mg/dL was independently associated with an increased incidence of cardiovascular death (adjusted hazard ratio, 1.68 [95% CI, 1.30–2.17]) and 3‐point major adverse cardiovascular event (adjusted hazard ratio, 1.37 [95% CI, 1.10–1.71]). Conclusions In this Korean acute myocardial infarction registry, the baseline LDL‐C level <70 mg/dL was significantly associated with an increased incidence of long‐term cardiovascular events after discharge. (COREA [Cardiovascular Risk and Identification of Potential High‐Risk Population]‐Acute Myocardial Infarction Registry; NCT02806102). Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02806102. |
| first_indexed | 2024-04-12T18:56:03Z |
| format | Article |
| id | doaj.art-bdf261e29d604ac09a7375585be0b053 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T18:56:03Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-bdf261e29d604ac09a7375585be0b0532022-12-22T03:20:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-09-01111710.1161/JAHA.122.025958Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial InfarctionKyung Hoon Cho0Min Chul Kim1Eun Ho Choo2Ik Jun Choi3Su Nam Lee4Mahn‐Won Park5Chul Soo Park6Hee‐Yeol Kim7Chan Joon Kim8Doo Sun Sim9Ju Han Kim10Young Joon Hong11Myung Ho Jeong12Kiyuk Chang13Youngkeun Ahn14Department of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of KoreaDepartment of Cardiology Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of KoreaDepartment of Cardiology St Vincent’s Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of KoreaDepartment of Cardiology Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of KoreaDepartment of Cardiology Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of KoreaDepartment of Cardiology Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Bucheon Republic of KoreaDepartment of Cardiology Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaDepartment of Cardiology Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of KoreaDepartment of Cardiology Chonnam National University Hospital Gwangju Republic of KoreaBackground Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (<70, 70–99, and ≥100 mg/dL), as LDL‐C levels decreased, clinical outcomes worsened (237/3759 [6.3%] in LDL‐C ≥100 mg/dL versus 123/1291 [9.5%] in LDL‐C 70–99 mg/dL versus 86/482 [17.8%] in LDL‐C <70 mg/dL for cardiovascular death; P‐trend<0.001; and 417/3759 [11.1%] in LDL‐C ≥100 mg/dL versus 172/1291 [13.3%] in LDL‐C 70–99 mg/dL versus 106/482 [22.2%] in LDL‐C <70 mg/dL for 3‐point major adverse cardiovascular event; P‐trend<0.001). In a Cox time‐to‐event multivariable model with LDL‐C levels ≥100 mg/dL as the reference, the baseline LDL‐C level <70 mg/dL was independently associated with an increased incidence of cardiovascular death (adjusted hazard ratio, 1.68 [95% CI, 1.30–2.17]) and 3‐point major adverse cardiovascular event (adjusted hazard ratio, 1.37 [95% CI, 1.10–1.71]). Conclusions In this Korean acute myocardial infarction registry, the baseline LDL‐C level <70 mg/dL was significantly associated with an increased incidence of long‐term cardiovascular events after discharge. (COREA [Cardiovascular Risk and Identification of Potential High‐Risk Population]‐Acute Myocardial Infarction Registry; NCT02806102). Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02806102.https://www.ahajournals.org/doi/10.1161/JAHA.122.025958acute coronary syndromecholesterolLDLmyocardial infarctionpercutaneous coronary intervention |
| spellingShingle | Kyung Hoon Cho Min Chul Kim Eun Ho Choo Ik Jun Choi Su Nam Lee Mahn‐Won Park Chul Soo Park Hee‐Yeol Kim Chan Joon Kim Doo Sun Sim Ju Han Kim Young Joon Hong Myung Ho Jeong Kiyuk Chang Youngkeun Ahn Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute coronary syndrome cholesterol LDL myocardial infarction percutaneous coronary intervention |
| title | Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction |
| title_full | Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction |
| title_fullStr | Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction |
| title_full_unstemmed | Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction |
| title_short | Impact of Low Baseline Low‐Density Lipoprotein Cholesterol on Long‐Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction |
| title_sort | impact of low baseline low density lipoprotein cholesterol on long term postdischarge cardiovascular outcomes in patients with acute myocardial infarction |
| topic | acute coronary syndrome cholesterol LDL myocardial infarction percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.025958 |
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