PURPOSE: Clinical profile and long term outcomes in patients with acute coronary syndrome (ACS) and low density lipoprotein (LDL) < 70 mg/dl at the time of hospital presentation are unclear. To determine, in a group of patients admitted with ACS, if those with LDL < 70 mg/dl differ from patients with LDL >70 mg/dl, regarding clinical profile and outcomes.
METHODS: A total of 555 consecutive patients with previous dyslipidaemia admitted with ACS were evaluated and divided in two groups: A –LDL<70 mg/dl (20 patients) and B –LDL>70 mg/dl (535 patients). Clinical follow-up was available for 401 patients (72.25%) with a mean duration of 18 months.
RESULTS: There were no significant differences between the two groups regarding age, gender, family history, hypertension, smoking, previous myocardial infarction, PTCA, CABG, coronary artery disease, stroke, recent hospitalization and TIMI risk score. Patients with LDL<70mg/dl were more likely to be on statins, aspirin, beta-blockers and nitrates before admission. Diabetes mellitus was also more frequent in these patients (65% versus 36%, p=0.009) and their HDL cholesterol was significant lower (34.0 versus 41.0; p=0.002). Intra-hospital mortality and morbidity were significantly higher in patients with LDL <70 mg/dL (30% versus 2.2% and 30% versus 3.8%; p<0.001). Cardiovascular complications during follow-up were 87.5% for patients with LDL<70 mg/Dl and 33.4% for patients with LDL>70 mg/dL. Although, no significant difference was found between groups regarding follow-up all-cause mortality.
CONCLUSION: Although having a better lipid profile, ACS patients with LDL <70 mg/dL have a worse in-hospital and post-discharge outcome. This result may be due to the high risk status of this population.
CLINICAL IMPLICATIONS: The need for aggressive risk management in this patient cohort.
DISCLOSURE: Elisabete Jorge, No Financial Disclosure Information; No Product/Research Disclosure Information