P4615Dyslipidemia as a predictor of no-reflow after primary PCI in STEMI pts

Abstract

Abstract According to current guidelines all pts with ACS should be treated by intensive statin therapy, independently of baseline cholesterol level. However, the significance of baseline lipid profile for the results of treatment in STEMI pts has been insufficiently studied. The aim of the study was to evaluate baseline lipids level in STEMI patients with different degrees of tissue blood flow recovery after primary PCI. Methods 110 pts with STEMI admitted within 24 hrs (4.5±1.2 h) from symptoms onset and treated by primary PCI were included. Patients were treated according to current guidelines, and intensive statin therapy was initiated before any intervention. Blood lipids were tested at admission. Myocardial Blush Grade (MBG) was used for angiographic assessment of myocardial reperfusion. Dyslipidemia was assessed by total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) / HDL-C ratios. Results Good restoration of microvascular perfusion (MBG3) was found in 44 (40%) pts, MBG2 was achieved in 32 (29%) pts, while poor microvascular flow was seen 34 (31%) pts (MBG1 in 17 (15,5%) pts and MBG0 in 17 (15,5%) pts). Pts with MBG0 tended to have higher TC and triglycerides (TG) levels and lower HDL-C levels at baseline. TC/ HDL-C and LDL-C/HDL-C ratios that usually used to predict ischemic heart disease risk were also significantly higher in pts with no-reflow phenomenon (MBG0) (table 1) Table 1 MBG 0 MBG 1 MBG 2 MBG 3 p N=17 (15.5%) N=17 (15.5%) N=32 (29%) N=44 (40%) TC, mmol/l 6.42±0.23 5.9±0.21 6.1±0.25 6.1±0.26 nd LDL-C, mmol/l 4.22±0.21 3.89±0.18 3.95±0.22 3.97±0.2 nd HDL-C, mmol/l 1.24±0.03 1.34±0.02 1.36±0.021 1.39±0.022 nd TG, mmol/l 2.53±0.12 1.8±0.11 1.9±0.11 1.9±0.1 nd nonHDL-C, mmol/l 4.84±0.18 4.69±0.17 4.55±0.19 4.59±0.18 nd LDL-C/HDL-C 3.45±0.17 2.98±0.18 3.02±0.16 2.76±0.15 0.016 TC/HDL-C 5.23±0.21 4.59±0.2 4.71±0.18 4.29±0.19 0.011 Conclusion TC/HDL-C and LDL-C/HDL-C ratios can be used to predict the development of no-reflow after pPCI in STEMI pts.