Perioperative Myocardial Injury/Infarction in Patients with Stable or Unstable Angina Pectoris Undergoing Elective Percutaneous Coronary Intervention: The Effects of Preoperative Lipid Management.

Background: Identifying the risk factors for perioperative myocardial injury/infarction (PMI) is critical to prevent postoperative adverse cardiovascular events. However, whether reducing the preoperative LDL-C can mitigate the risk of PMI remains unclear. We therefore investigated the effect of the preoperative LDL-C level in patients with stable angina pectoris (SAP) or unstable angina pectoris (UAP) on perioperative myocardial injury/infarction (PMI) after elective percutaneous coronary intervention (PCI).

Methods: Patients with SAP or UAP who received PCI from January 2021 to June 2023 at one of the two institutions (Hebei Provincial People's Hospital, Handan Central Hospital) were reviewed. The occurrence of PMI was determined based on the elevation of cardiac troponin I (cTnI) after the operation. The preoperative low density lipoprotein cholesterol (LDL-C) level was divided into three grades: low, <1.4 mmol/L; medium, 1.4-1.8 mmol/L; high, >1.8 mmol/L. The relationship between PMI and preoperative LDL-C was analyzed.

Results: Of all 308 included patients, 226 did not have PMI and 82 experienced PMI. Positive correlation was found both between PMI and preoperative LDL-C level (r = 0.322, P < 0.05) and between PMI and preoperative LDL-C grade (r = 0.189, P < 0.05). According to the multivariate logistic regression analysis, the preoperative LDL-C grade (Medium vs Low, OR=3.994, P < 0.05; High vs Medium, OR=6.140, P < 0.05) and the number of stents implanted during PCI were independent risk factors for PMI (OR=1.940; P < 0.05).

Conclusion: For SAP and UAP patients, decreasing LDL-C to <1.4 mmol/L before elective PCI can reduce the incidence of PMI after the operation. We strongly recommend the practice of sufficiently reducing LDL-C level below 1.4 for patients with SAP or UAP who receive elective PCI.