Association of HDL-C levels with all-cause mortality in ACS patients after PCI: a multicenter prospective cohort study.

The association between high-density lipoprotein cholesterol (HDL-C) levels and prognosis in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the relationship between HDL-C levels and all-cause mortality in this population. This multicenter prospective cohort study included 17,180 ACS patients who underwent PCI from the Multicenter Prospective Cohort Study on Acute Coronary Syndrome (MPCS-ACS). HDL-C levels were categorized into four groups: < 30, 30-60, 60-90 (reference), and ≥ 90 mg/dL. The primary endpoint was all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with multivariable adjustments. During a median follow-up of 49 months, 1200 all-cause mortality events occurred. U-shaped associations were observed between HDL-C levels and risks of all-cause mortality. After multivariable adjustment, compared to patients with HDL-C levels of 60-90 mg/dL, ACS patients with HDL-C < 30 mg/dL or ≥ 90 mg/dL had a significantly increased risk of all-cause mortality, with HRs [95% CI] of 3.52 (2.66-4.64) and 2.71 (2.10-3.50), respectively. Both extremely low and high HDL-C levels were associated with increased risk of all-cause mortality in ACS patients undergoing PCI. Maintaining HDL-C levels within the 60-90 mg/dL range may be associated with better long-term outcomes.