Pro-oxidant HDL predicts poor outcome in patients with ST-elevation acute coronary syndrome

Klaus Distelmaier; Lore Schrutka; Veronika Seidl; Max P. Winter; Raphael Wurm; Andreas Mangold; Thomas Perkmann; Gerald Maurer; Christopher Adlbrecht; Irene M. Lang

doi:10.1160/TH14-10-0834

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 114(01): 133-138
DOI: 10.1160/TH14-10-0834

Cellular Signalling and Proteolysis

Schattauer GmbH

Pro-oxidant HDL predicts poor outcome in patients with ST-elevation acute coronary syndrome

Klaus Distelmaier

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Lore Schrutka

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Veronika Seidl

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Max P. Winter

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Raphael Wurm

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Andreas Mangold

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Thomas Perkmann

²Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria

,

Gerald Maurer

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

,

Christopher Adlbrecht

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

³4th Department of Internal Medicine, Division of Cardiology, Hietzing Hospital, Teaching Hospital of the Medical University of Vienna, Vienna, Austria

,

Irene M. Lang

¹Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria

› Author Affiliations

Abstract

Summary

Oxidative stress affects clinical outcome in patients with ST-elevation acute coronary syndrome (STE-ACS). Although high-density lipoprotein (HDL) particles are generally considered protective, deleterious properties of HDL have been observed in patients with acute myocardial infarction. Here, we analysed the association between pro oxidant HDL and all-cause mortality in STE-ACS patients. We determined the antioxidant function of HDL in 247 prospectively enrolled patients undergoing primary percutaneous coronary intervention for STE-ACS. Patients were stratified as by a pro-oxidant serum HDL oxidant index (HOI 1) or with an antioxidant serum HOI (HOL< 1) capacity. Multivariate regression analysis was used to relate HOI to survival. The median follow-up time was 23 months (IQR 14.4–40.0 months). Pro-oxidant HDL was observed in 44.1 % of STE-ACS patients and was independently associated with all-cause mortality with a hazard ratio of 3.30(95 %CI 1.50–7.27, p = 0.003). Mortality rates were higher in patients with baseline pro-oxidant HDL compared to patients with preserved HDL function at 30 days (11.9 % vs 2.2 %, p=0.002), and at 4 years (22.9 % vs 8.7 %, p=0.002). Elevated neutrophil counts were a strong and independent predictor for pro-oxidant HDL with an odds ratio per standard deviation of 1.50 (95 %CI 1.11–2.03, p=0.008), as was history of prior acute myocardial infarction, elevated triglycerides levels and reduced glomerular filtration rate. In conclusion, pro-oxidant HDL represents a strong and independent predictor of long-term as well as short-term all-cause mortality in STE-ACS patients. Elevated neutrophil counts predicted the presence of serum pro-oxidant HDL. The maintenance of HDL functions might be a promising therapeutic target in STE-ACS patients.

Keywords

STE-ACS - HDL - antioxidant function - outcome

Full Text

References

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