Relationship of High‐Density Lipoprotein Cholesterol With Periprocedural Myocardial Injury Following Elective Percutaneous Coronary Intervention in Patients With Low‐Density Lipoprotein Cholesterol Below 70 mg/dL

BACKGROUND: Recent data showed inconsistent association of high‐density lipoprotein cholesterol (HDL‐C) with cardiovascular risk in patients with different levels of low‐density lipoprotein cholesterol (LDL‐C) or intensive statin therapy. This study sought to determine the relationship of HDL‐C with periprocedural myocardial injury following elective percutaneous coronary intervention (PCI) across a range of LDL‐C levels, especially in patients with LDL‐C <70 mg/dL. METHODS AND RESULTS: We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who underwent elective PCI. The association between preprocedural HDL‐C and periprocedural myocardial injury was evaluated across LDL‐C levels, especially in patients with LDL‐C <70 mg/dL. The HDL‐C level was not predictive of periprocedural myocardial injury across the entire study cohort. However, among patients with LDL‐C <70 mg/dL, a 1 mg/dL increase in HDL‐C was associated with a 3% reduced risk for postprocedural cTnI above 1×upper limit of normal (ULN) (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.004), a 3% reduced risk for postprocedural cTnI above 3×ULN odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.022), and a 3% reduced risk for postprocedural cTnI above 5×ULN (odds ratio: 0.97; 95% CI: 0.95 to 0.99; P=0.017). The relation between plasma HDL‐C level and risk of postprocedural cTnI elevation above 1×ULN, 3×ULN, and 5×ULN was modified by LDL‐C level (all P for interaction <0.05). CONCLUSIONS: Higher HDL‐C levels were associated with reduced risk of periprocedural myocardial injury only in patients with LDL‐C <70 mg/dL.