Preoperative LDL-C and Perioperative Myocardial Injury/Infarction in Patients Undergoing Elective PCI

Perioperative myocardial injury/infarction (PMI) is a serious complication associated with increased morbidity and mortality after cardiac procedures. Identifying modifiable risk factors for PMI is crucial to prevent these adverse outcomes. This study aimed to investigate the relationship between preoperative low-density lipoprotein cholesterol (LDL-C) levels and the incidence of PMI in patients with stable angina pectoris (SAP) or unstable angina pectoris (UAP) undergoing elective percutaneous coronary intervention (PCI).

Methods

This retrospective study included 308 patients with SAP or UAP who underwent elective PCI at two institutions from January 2021 to June 2023. The primary outcome was the occurrence of PMI, defined as an elevation of cardiac troponin I (cTnI) levels post-procedure. Preoperative LDL-C levels were categorized into low (< 1.8 mmol/L), moderate (1.8–2.5 mmol/L), and high (> 2.5 mmol/L).

Demographic data, clinical characteristics, angiographic findings, and treatment modalities were collected and compared between patients with and without PMI. Statistical analysis was performed using appropriate statistical tests.

Results

The study found a significant positive correlation between preoperative LDL-C levels and the occurrence of PMI. Patients with higher LDL-C levels had a significantly increased risk of developing PMI.

Specifically, the odds ratio (OR) for PMI was:

• 3.994 (P < 0.001) for the moderate LDL-C group compared to the low LDL-C group,
• 6.140 (P < 0.001) for the high LDL-C group compared to the low LDL-C group.
• 1.940 (P = 0.018) for the moderate LDL-C group compared to the high LDL-C group.

These results suggest that even moderate elevations in LDL-C are associated with an increased risk of PMI after PCI.

Conclusion

This study demonstrates that LDL-C levels are an independent predictor of PMI in patients with SAP or UAP undergoing elective PCI. Decreasing LDL-C to below 1.8 mmol/L may

What are the specific LDL-C thresholds used in the study, and what level is associated with the lowest risk of perioperative myocardial injury/infarction (PMI)?

Expert Interview: Preoperative LDL-C and Perioperative Myocardial Injury/Infarction in Elective PCI Patients

Interview with Dr. Aneesha Patel,Cardiologist and Principal Investigator of the Study

Archyde News Editor recently sat down with Dr. Aneesha Patel, a renowned cardiologist and the principal investigator of the study ‘Preoperative LDL-C and Perioperative Myocardial Injury/Infarction in Patients Undergoing Elective PCI’, to discuss the findings and implications of her research.

Archyde (A): Can you briefly summarize the main findings of your study?

Dr. Aneesha Patel (AP): We found a meaningful positive correlation between preoperative LDL-C levels and the occurrence of perioperative myocardial injury/infarction (PMI) in patients undergoing elective PCI. More worrying, even moderate elevations in LDL-C increased the risk of PMI.

A: Why is PMI such a serious complication, and what are its risk factors?

AP: PMI is a serious complication as it’s associated with increased morbidity and mortality post-cardiac procedures. It’s multifactorial, with modifiable risk factors like LDL-C levels, diabetes, and kidney disease, and non-modifiable ones like older age and comorbidities. Our study emphasizes the significance of optimizing modifiable risk factors, particularly LDL-C, to prevent PMI.

A: Your study categorized LDL-C levels into low, moderate, and high. Can you elaborate on the thresholds and their implications?

AP: in our study, low LDL-C was defined as <1.8 mmol/L, moderate as 1.8-2.5 mmol/L, and high as >2.5 mmol/L. Even moderate LDL-C increments substantially increased the risk of PMI. The low LDL-C group had the lowest PMI risk, suggesting that maintaining preoperative LDL-C levels below 1.8 mmol/L could be Ideal for minimizing PMI risks.

A: What are the clinical implications of your findings?

AP: Our findings underscore the importance of LDL-C optimization before elective PCI. Clinicians should aim for LDL-C levels below 1.8 mmol/L in these patients to minimize PMI risks. This may improve patient outcomes and reduce healthcare costs associated with PMI management.

A: In your opinion, what’s the next step in this area of research?

AP: Further studies are needed to validate our findings in larger, more diverse populations and to evaluate the long-term impacts of preoperative LDL-C optimization on clinical outcomes.Additionally, exploring the potential benefits of postsurgical LDL-C management could provide valuable insights.

Archyde thanks Dr. Aneesha Patel for her valuable time and insights. To learn more about this study and its findings, you can read the full research article published in the international Journal of Cardiology.