Available online 30 July 2022
Author links open overlay panelTaitoAraiMD1*TeruoSekimotoMD, PhD1*ShinjiKobaMD, PhD12HiroyoshiMoriMD, PhD3NaokiMatsukawa4RikuoSakaiMD1YuyaYokotaMD, PhD1ShunyaSatoMD, PhD1HideakiTanakaMD, PhD1RyotaMasakiMD1YosukeOishiMD, PhD1KunihiroOguraMD, PhD1KenAraiMD, PhD1KosukeNomuraMD, PhD1KoshiroSakaiMD, PhD1HiroakiTsujitaMD, PhD1SeitaKondoMD, PhD1ShigetoTsukamotoMD, PhD1…ToshiroShinkeMD, PhD1AbstractBackground: Plaque rupture (PR), characterized by a disruption of the fibrous cap of lipid-rich plaques, is the major etiology of ST-segment elevation myocardial infarction (STEMI). Dyslipidemia is a well-known risk factor for PR. Nonetheless, the impact of detailed atherogenic lipid profiles, including small dense low-density lipoprotein cholesterol (sd-LDL-C) and triglyceride-rich lipoproteins (TRLs), on PR has not yet been investigated.
Objective: To elucidate the impact of sd-LDL-C and TRL levels on PR in patients with STEMI using optical coherence tomography (OCT).
Methods: A total of 106 consecutive statin-naive patients with STEMI were enrolled. The PR in culprit lesions was assessed on pre-intervention OCT images, and serum samples were collected immediately before coronary angiography. Sd-LDL-C was directly measured using a homogeneous assay. TRL-cholesterol (TRL-C) was estimated by subtracting the LDL-C level from the non-high-density lipoprotein cholesterol level. Clinical characteristics and lipid profiles were compared between the PR and intact fibrous cap (IFC).
Results: No difference in LDL-C levels was observed between the PR (n=64) and IFC (n=42) groups (120.0 mg/dL vs. 129.5 mg/dL, p=0.97); however, sd-LDL-C levels were significantly higher in the PR group (38.9 mg/dL vs. 32.4 mg/dL, p=0.04). Similarly, the PR group had higher TRL-C (24.0 mg/dL vs. 18.0 mg/dL, p=0.01) and triglyceride (130.0 mg/dL vs. 100.3 mg/dL, p=0.03) levels than the IFC group. Multivariate logistic regression analysis showed that sd-LDL-C was an independent factor determining PR (odds ratio, 1.53 per 10 mg/dL; p=0.04).
Conclusion: Only sd-LDL-C levels were significantly associated with PR in culprit lesions in patients with STEMI.
KeywordsSmall dense low-density lipoprotein cholesterol
Triglyceride-rich lipoproteins
Plaque rupture
ST-segment elevation myocardial infarction
Optical coherence tomography
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