Relation Of High Density Lipoprotein Cholesterol Level In Pre-operation With Prognosis Of Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective: To investigate the relation of the pre-operation of high density lipoprotein cholesterol(HDL-C) on clinical prognosis in patients with ST-segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PCI). To understand the relationship between the different levels of the pre-operation HDL-C and myocardial ischemia-reperfusion injury(MIRI)and the major adverse cardiac events(MACE) in patients with STEMI.Methods:(1) 271 patients with STEMI treated with PCI in The navy general hospital in Beijing from January 2012 to December 2014 were enrolled in the study. The subjects were divided into two groups according to whether the MACE happen[the MACE event group(n=55);the non-MACE event group(n=216)]. Compared preoperative HDL-C level in two groups.Through the logistic regression analysis to know the influence of pre-operative HDL- C level on hospital of major cardiovascular events in patients with STEMI.(2) 118 patients with STMI treated with PCI in our hospital from January 2012 to January 2013 were enrolled in the study. The subjects were divided into two groups according to whether the preoperative HDL-C level normal[the low group(n=46):HDL-C<1.04mmol/L;the normal group(n=72):HDL-C?1.04mmol/L].The differences of MACE rates and MIRI status between the low group and the normal group were compared.Results:(1)(1)Compared with the non-MACE group, the MACE group patients of the preoperative HDL-C levels was lower(1.03±0.29 mmol/L vs 1.16±0.26 mmol/L,P=0.002)and the proportion of patients with the low levels preoperative HDL-C level was higher(65.5% vs. 40.7%, P = 0.001).The difference was statistically significant.(2)By the logistic regression analysis showed that the preoperative HDL-C levels is independent protection factors of short-term MACE events(OR = 0.105, 95% CI: 0.081 ~ 0.615, P = 0.012).And Compared with the normal group, the low levels group of in-hospital MACE events risk is 2.551 times(OR = 2.551, 95% CI: 1.110 ~ 5.862, P = 0.027).(2)(1) Compared with the low HDL-C group, The differences of the level of the preoperative total cholesterol(TC) and apolipoprotein A were higher in normal group.The remaining baseline features had no difference between two group.(2)Compared with normal group, the reperfusion arrhythmia(RA) rate([76% VS 58%, P=0.048)and serum creatine phosphokinase isoenzyme MB(CK-MB) peak value(3173±1905 U/L VS 2396±1994 U/L,P=0.038)were higher, and the level of left ventricular ejection fraction(LVEF) was lower[(51.2±7)%VS(56.3±8)%,P<0.001)] in low group.(3)Compared with the low HDL-C group,the in-hospital MACE rate was lower in normal group(28% VS 11%P=0.018).(4) There were no difference within 1 year MACE rate after PCI between two groups.(5)Partial correlation analysis showed that: To adjust those factors of the time of onset to admission PCI treatment, Gensini score and the preoperative total cholesterol, the levels of preoperative HDL-C and CK peak,CK-MB peak and C-reactive protein have a negative correlation. The correlation coefficient is-0.196(P = 0.036) ?-0.196(P = 0.036)?-0.208(P=0.026), respectively, and correlated significantly. The levels of preoperative HDL-C and the postoperative LVEF have a positively correlation. The correlation coefficient is 0.210(P = 0.024), and correlated significantly.Conclusion:(1)The low level of preoperative HDL-C is independent risk factor of in-hospital MACE.(2) The patients with STEMI treated by emergency PCI, the level of preoperative HDL- C have a closely related to inflammation and postoperative ejection fraction. The high levels of preoperative HDL-C may be a protect factors of myocardial ischemia-reperfusion.