Document Detail


Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction.
MedLine Citation:
PMID:  19437396     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The relationship between admission low-density lipoprotein (LDL) levels and long-term outcomes has not been established in patients with acute coronary syndrome. We tested the hypothesis that patients who develop non-ST segment elevation myocardial infarction (NSTEMI) despite low LDL have a worse cardiovascular outcome in the long term. METHODS: Patients admitted with NSTEMI between 1 January 1997 and 31 December 2000 and with fasting lipid profiles measured within 24 hours of admission were selected for analysis. Baseline characteristics and 3-year all-cause mortality were compared between the patients with LDL above and below the median. Multivariate analysis was used to determine the predictors of all-cause mortality, and adjusted survival was analyzed using the Cox proportional hazard model. RESULTS: Of the total of 517 patients, 264 had LDL <or= 105 mg/dL and 253 had LDL > 105 mg/dL. There was no difference in age, gender, severity of coronary artery disease, and left ventricular ejection fraction between the 2 groups. Thirty-six percent of patients with LDL <or= 105 mg/dL and 24% of patients with LDL > 105 mg/dL were on lipid-lowering therapy on admission. After 3 years, patients with admission LDL <or= 105 mg/dL had higher all-cause mortality rate compared to patients with LDL > 105 mg/dL (14.8% vs. 7.1%, p = 0.005). The higher all-cause mortality persisted (OR 1.8, 95% CI 1.0-3.5, p = 0.05) even after adjustment for confounding variables. CONCLUSIONS: In our cohort, lower LDL-cholesterol at admission was associated with decreased 3-year survival in patients with NSTEMI. Whether this was a result of current therapy or a marker for worse baseline characteristics needs to be studied further.
Authors:
Mouaz H Al-Mallah; Hazem Hatahet; João L Cavalcante; Sanjaya Khanal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiology journal     Volume:  16     ISSN:  1897-5593     ISO Abbreviation:  -     Publication Date:  2009  
Date Detail:
Created Date:  2009-05-13     Completed Date:  2009-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101392712     Medline TA:  Cardiol J     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  227-33     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Henry Ford Heart and Vascular Institute, Detroit, MI 48202, USA. malmall1@hfhs.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Cholesterol, LDL / blood*
Down-Regulation
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction / blood*,  mortality*,  therapy
Odds Ratio
Patient Admission*
Proportional Hazards Models
Registries
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Cholesterol, LDL
Comments/Corrections
Comment In:
Cardiol J. 2009;16(3):195-6   [PMID:  19437392 ]

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