Abstract 17474: Management State of Low-Density Lipoprotein Cholesterol has a Favorable Effect on Left Ventricular Reverse Remodeling in Patients With ST-Segment Elevation Acute Myocardial Infarction

Abstract

Left ventricular remodeling following ST elevation acute myocardial infarction (STEMI) is still an issue in the primary percutaneous coronary intervention (PCI) era. This study aimed to examine whether control of cholesterol levels is predictive of reverse remodeling in patients with STEMI. Subjects were 56 patients with first STEMI successfully and completely reperfused. Single photon emission computed tomography (SPECT) was used to measure LV function at 1 and 6 months after onset. Reverse remodeling was defined as a >10% reduction in LV end-systolic volume at 6-month follow-up compared with baseline SPECT. Patients were divided into reverse remodeling (n=15) and non-reverse remodeling (n=41) groups, and clinical characteristics including age, sex, body mass index, peak serum creatine kinase, number of coronary artery lesions, coronary risk factors and medications, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C ratio, and triglycerides were compared between the groups. We examined the proportions of patients with target LDL-C (<70 mg/dL), HDL-C (≥40 mg/dL), and TG (<150 mg/dL) levels, and LDL-C/HDL-C ratio of <1.5. Multivariate stepwise logistic regression analyses were performed to evaluate the relationship between occurrence of reverse remodeling and clinical characteristics. In baseline clinical characteristics, there were significant differences between the two groups regarding to management states of LDL-C levels and the LDL/HDL ratio. The proportions of patients achieving target LDL-C levels and LDL-C/HDL-C ratio were higher in the reverse remodeling group than in the non-reverse remodeling group (80% and 17%, p<0.0001; 60% and 10%, p<0.0001, respectively). Logistic regression analysis revealed that patients with target LDL-C levels were significantly more likely to show reverse remodeling (odds ratio 19.429, 95% confidence interval 4.317-87.432, p<0.0001). The present study showed that the good control of LDL-C independently predicts reverse remodeling in patients with first STEMI. This finding underscores the need for achieving and maintaining target LDL-C levels through secondary prevention for reverse remodeling.