The Clinical Value of Modified Low Density Lipoprotein-Cholesterol in Patients Who Underwent Percutaneous Coronary Intervention

Nam Sik Yoon; Myung Ho Jeong; Young Aeh Kim; Woo Suk Lee; Sun Ho Hwang; Sang Rok Lee; Seo Na Hong; Kye Hun Kim; Hyung Wook Park; Ju Han Kim; Young Keun Ahn; Jeong Gwan Cho; Jong Chun Park; Jung Chaee Kang

doi:10.4070/kcj.2008.38.9.475

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Yoon, Jeong, Kim, Lee, Hwang, Lee, Hong, Kim, Park, Kim, Ahn, Cho, Park, and Kang: The Clinical Value of Modified Low Density Lipoprotein-Cholesterol in Patients Who Underwent Percutaneous Coronary Intervention

Original Article

Korean Circulation Journal

Korean Circulation Journal 2008; 38(9): 475-482.

Published online: 30 September 2008

DOI: https://doi.org/10.4070/kcj.2008.38.9.475

The Clinical Value of Modified Low Density Lipoprotein-Cholesterol in Patients Who Underwent Percutaneous Coronary Intervention

Nam Sik Yoon, MD, Myung Ho Jeong, MD, Young Aeh Kim, MT, Woo Suk Lee, MD, Sun Ho Hwang, MD, Sang Rok Lee, MD, Seo Na Hong, MD, Kye Hun Kim, MD, Hyung Wook Park, MD, Ju Han Kim, MD, Young Keun Ahn, MD, Jeong Gwan Cho, MD, Jong Chun Park, MD, Jung Chaee Kang, MD

The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.

Correspondence: Myung Ho Jeong, MD, The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 8 Hak 1-dong, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-220-6243, Fax: 82-62-228-7174, myungho@chollian.net

Received 15 June 2007 Revised 12 February 2008 Accepted 23 April 2008

Abstract

Background and Objectives

It is well known that atherosclerosis is characterized by chronic inflammation of an injured intima and the pathological processes are initiated by an accumulation of morphologically distinct, modified forms of low density lipoprotein (LDL)-cholesterol. However, it is not well known whether the level of modified LDL-cholesterol has clinical significance for the patients who underwent percutaneous coronary intervention (PCI).

Subjects and Methods

Eighty seven patients (mean age: 63.0 ± 11.1 years, 58 men) who underwent PCI were enrolled. The patients with stable or unstable angina pectoris were classified as group I (n=44, mean age: 62.4 ± 9.3 years), and the patients with acute myocardial infarction were classified as group II (n=43, mean age: 63.6 ± 12.7 years). Modified LDL-cholesterol was expressed semiquantitatively by agarose gel electrophoresis with using the charge modification frequency (CMF). The clinical and coronary angiographic data was analyzed.

Results

The clinical diagnosis was stable angina in 13 patients, unstable angina in 31 patients, non-ST elevation myocardial infarction in 5 patients and ST elevation myocardial infarction in 38 patients. There were no significant differences of the CMF between two groups (3.0 ± 7.9 vs. 2.1 ± 10.9, respectively, p=0.671). The diameter stenosis was severe in the patients with a CMF greater than 10 (84.0 ± 10.4% vs. 78.6 ± 13.7%, respectively, p=0.047). The six-month major adverse cardio-vascular events (MACEs) had no relationship with the CMF in group I. However, in group II, the 6-month MACEs developed more frequently in the patients with a CMF higher than 10 {2 (28%) for group ll vs. 2 (5%) for group 1, p=0.031}. The patients with acute myocardial infarction and whose CMF was higher than 10 had in-stent restenosis observed on their follow-up coronary angiography (p=0.003).

Conclusion

A higher level of modified LDL-cholesterol is associated with severe angiographic findings and a poor prognosis for patients with acute myocardial infarction.

Keywords: Lipoprotein, Acute coronary syndrome

Figures and Tables

Fig. 1

Calculation of the charge modification frequency on the agarose gel electrophoresis. LDL-C: low density lipoprotein-cholesterol.

Fig. 2

Two examples of the charge modification frequency on the agarose gel electrophoresis. A: CMF=0. B: CMF=54. CH: cholesterol, TG: triglyceride, LDL-C: low density lipoprotein-cholesterol, HDL-C: high density lipoprotein-cholesterol, VLDL-C: very low density lipoprotein-cholesterol, CHYLO: chylomicron.

Table 1

Baseline clinical characteristics

BMI: body mass index

Table 2

Lipid profile

LDL-C: low density lipoprotein-cholesterol, HDL-C: high density lipoprotein-cholesterol, VLDL-C: very low density lipoprotein-cholesterol

Table 3

Coronary angiographic findings according to the CMF

CMF: charge modification frequency, ACC/AHA: American College of Cardiology/American Heart Association, TIMI: Thrombolysis In Myocardial Infarction

Table 4

Baseline clinical characteristics according to the CMF

CMF: charge modification frequency, BMI: body mass index, LDL-C: low density lipoprotein-cholesterol, HDL-C: high density lipoprotein-cholesterol, VLDL-C: very low density lipoprotein-cholesterol

Table 5

Coronary angiographic finding according to the level of charge modification frequency (CMF)

MLD: minimal luminal diameter, PCI: percutaneous coronary intervention

Table 6

Coronary angiographic findings

ACC/AHA: American College of Cardiology/American Heart Association, TIMI: Thrombolysis In Myocardial Infarction

Table 7

Coronary angiographic follow-up and the in-stent restenosis

AMI: acute myocardial infarction, AP: angina pectoris, PCI: percutaneous coronary intervention, F/U: follow up, CMF: charge modification frequency, CAG: coronary angiography, ISR: instent restenosis, BMS: bare metal stent, DES: drug eluting stent

Table 8

Coronary angiographic findings and six-month MACEs in the patients with myocardial infarction according to the level of CMF

CMF: charge modification frequency, MLD: minimal luminal diameter, PCI: percutaneous coronary intervention, MACE: major adverse cardiac event

Table 9

Coronary angiographic findings and the six-month MACEs in patients with angina pectoris, according to the level of CMF

CMF: charge modification frequency, MLD: minimal luminal diameter, PCI: percutaneous coronary intervention, MACE: major adverse cardiac event

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