Abstract 10198: Association Between Admission Low-Density Lipoprotein Cholesterol and In-Hospital Mortality Among Inpatients with Acute Myocardial Infarction in China: Findings from CCC-ACS Project

Abstract

Introduction: Lowering low-density lipoprotein cholesterol (LDL-C) to <1.4 mmol/L is an important strategy for most patients with acute myocardial infarction (AMI) in secondary prevention of cardiovascular diseases. The association between admission LDL-C levels and all-cause mortality during acute period of AMI is not well established. This study aims to examine the relation between admission LDL-C levels and the risk of in-hospital all-cause mortality among patients with AMI. Methods: The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project is a nationwide registry study. Admission LDL-C level associated with in-hospital all-cause mortality were evaluated on a continuous scale with restricted cubic splines and by categories with multivariate Cox regression models among 94623 inpatients with AMI in 159 tertiary hospitals and 82 secondary hospitals in 30 provinces from November 2014 to December 2019. Results: Among total inpatients, 1852 cases (2.0%) died, 5434 patients (5.7%) have LDL-C level<1.4 mmol/L. The association between LDL-C levels and the risk of all-cause mortality was U shaped, with low and high LDL-C levels associated with an increased risk. Compared with inpatients with LDL-C level of 1.4-1.8 mmol/L, the adjusted hazard ratio was 1.48 (95% confidence interval: 1.18 to 1.87) for patients with LDL-C< 1.4 mmol/L, and 1.50 (95%CI: 1.19 to 1.90) for patients with LDL-C≥ 4.1 mmol/L. Propensity score matched analysis confirmed these associations. Similar results were seen in both gender, in patients with and without diabetes, across age groups and triglycerides groups, across ST-segment elevation AMI and non-ST-segment elevation AMI patients, and after excluding patients who died within 24 hours after admission. However, such association was not observed in patients received lipid-lowering treatment before hospitalization and those treated with percutaneous coronary intervention during hospitalization. Conclusions: Lower LDL-C is associated with increased risk of in hospital all-cause mortality among patients hospitalized for AMI. Lower LDL-C levels may help identify patients at higher risk for in-hospital mortality, who could potentially benefit from intensification of treatment strategies.