Relationship between Pre-Procedural Serum Lipid Profile and Post-Procedural Myocardial Injury in Patients Undergoing Elective Percutaneous Coronary Intervention.

Background: Along with technological progress in coronary intervention, periprocedural complications and adverse outcomes have markedly improved, yet perioperative myocardial injury is a frequent complication during percutaneous coronary intervention (PCI) and is strongly associated with post-procedural cardiovascular morbidity and mortality. Epidemiological researchers have defined lipid and lipoproteins abnormality as a risk factor for atherosclerotic cardiovascular diseases. Although several studies focus on identification the correlation between the changes of lipid profile levels and ischemic markers, there is a little information about the role of lipid profile disturbance as a predictor of periprocedural myocardial injuries.

Objectives: This study aimed to observe the relationship between lipid profile levels and the post-procedural myocardial injury in patients undergoing elective PCI.

Patients And Methods: This case-control study was conducted on 138 consecutive patients with a diagnosis of coronary artery disease who underwent PCI. Of a total 138, 35 patients had cardiac biomarker elevation, more than 3 × ULN, post-procedurally. The control group (n = 103), without cardiac enzyme rising after PCI were randomly chosen three times the number of patients with increased cardiac enzymes more than three times the ULN. Samples for serum lipid parameters [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and very low-density lipoprotein cholesterol (VLDL)] were collected after 12-14 fasting hours immediately pre-procedurally. The samples for CPK-MB were collected at 8, 16, and 24 hours post procedurally.

Results: Although the mean level of TC, LDL-C and TG was higher in patients with CPK-MB more than 3×ULN post procedurally, differences were insignificant. Among different lipid parameters, only the mean level of VLDL showed a considerable association with myocardial injury. Although, this subject had a near significant (P = 0.05) enhancement in group I, the changes were in normal ranges. Lipid abnormality (except for the VLDL values) was insignificantly more frequent in group I.

Conclusions: Although the mean level of non-HDL-C was in normal ranges, it showed a higher value in patients with a diagnosis of myocardial injury post procedurally. However, according to multivariate analysis, left ventricular ejection fraction and diabetes remained as predictors of post-procedural CPK-MB elevation.