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.