医学
传统PCI
心肌梗塞
经皮冠状动脉介入治疗
逻辑回归
内科学
急诊医学
心脏病学
人口
环境卫生
作者
Haonan Sun,Ziping Li,Xiwen Song,Hangkuan Liu,Yongle Li,Yongchen Hao,Teng Tianmin,Jun Liu,Jing Liu,Dong Zhao,Xin Zhou,Qing Yang
出处
期刊:European heart journal. Acute cardiovascular care
[Oxford University Press]
日期:2021-07-15
卷期号:10 (9): 978-987
被引量:4
标识
DOI:10.1093/ehjacc/zuab053
摘要
Previous observations revealed a negative association between low-density lipoprotein cholesterol (LDL-C) and clinical outcomes following myocardial infarction, i.e., the lower level the higher mortality, which was referred to as lipid paradox. We sought to re-evaluate this association in ST-elevation myocardial infarction (STEMI) in contemporary practice.We examined the association between admission LDL-C and in-hospital mortality among 44 563 STEMI patients enrolled from 2014 to 2019 in a nationwide registry in China. A total of 43 covariates, which were temporally classified into the following three domains were used for adjustment: (i) pre-admission characteristics; (ii) percutaneous coronary intervention (PCI)-related variables; and (iii) other in-hospital medications. In-hospital mortality was 2.01% (897/44 563). When no covariate adjustment was performed, an inversely 'J-shaped' curve was observed between admission LDL-C levels and in-hospital mortality by restricted cubic spline in logistic regression, with a threshold value of <75 mg/dL that associated with increased risk for in-hospital mortality. However, a gradual attenuation for this association was noted when step-wise adjustments were performed, with the threshold values for LDL-C decreasing from 75 mg/dL to 70 mg/dL after accounting for pre-admission characteristics, further to 65 mg/dL after accounting for PCI-related variables, and finally to no statistical association after further adjustment for other in-hospital medications.In a nationwide registry in China, our findings do not support the lipid paradox in terms of in-hospital mortality in STEMI patients in contemporary practice. Previous findings in this scenario are possibly due to inadequate control for confounders.
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