Korean Circ J.  2008 Aug;38(8):419-424. 10.4070/kcj.2008.38.8.419.

The Early Treatment Gap of Dyslipidemia for Patients With Acute Myocardial Infarction

• Kil H
• Choi EY
• Lee WY
• Bae JW
• Whang KK
• Kim DW
• Cho MC

• KMID: 2225762
• DOI: http://doi.org/10.4070/kcj.2008.38.8.419

Abstract

BACKGROUND AND OBJECTIVES: A treatment gap for dyslipidemia can occur during the early phase of acute myocardial infarction (AMI) because the baseline low density lipoprotein-cholesterol (LDL-C) level during this period rapidly decreases physiologically.
SUBJECTS AND METHODS
We retrospectively reviewed the medical records of the patients who were admitted with AMI from December 2004 to July 2007 and their baseline LDL-C levels were less than 100 mg/dL. We analyzed the baseline lipid profiles and its serial changes in these patients. The initial LDL-C value, which can be expected to increase to over 100 mg/dL of LDL-C after discharge, was estimated statistically.
RESULTS
Among the 298 AMI patients, 94 (31.5%) patients showed a LDL-C level below 100 mg/dL. The LDL-C level increases between baseline and within 2 weeks, 2-6 weeks and 6 weeks after discharge were 11.8+/-22.5, 24.4+/-23.8 and 26.6+/-16.6 mg/dL, respectively. We made a receiver operating characteristics (ROC) curve of the LDL-C level at baseline and within 2 weeks after discharge for predicting the increment of the LDL-C level. Using the cutoff value 74 mg/dL for the initial LDL-C level, the sensitivity and specificity were 83% and 50%, respectively. With using an 81 mg/dL cutoff value at 2 weeks, the sensitivity and specificity were 83% and 62%, respectively.
CONCLUSION
A significant portion of AMI patients with an LDL-C level less than 100 mg/dL and who were not prescribed statin in the early phase of infarction showed an elevated LDL-C level over 100 mg/dL at 2 weeks after the infarction. The early administration of statin should be considered for treating an LDL-C=74 mg/dL during the initial period of AMI or an LDL-C=81 mg/dL at 2 weeks after AMI because their LDL-C level will increase to over 100 mg/dL during the subsequent follow-up period.

Keyword

Myocardial infarction; Dyslipidemia; Treatment

MeSH Terms

Dyslipidemias
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Infarction
Medical Records
Myocardial Infarction
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

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  Fig. 1 Percent change of the serum LDL-C between the baseline LDL-C level and LDL-C level of 2-6 weeks for the 51 patients with a baseline LDL-C <100 mg/dL. LDL-C: low density lipoprotein-cholesterol.

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  Fig. 2 ROC curve for the baseline and within 2 weeks LDL-C for expectation of 2 weeks after LDL-C is 100 mg/dL in patients with baseline LDL-C <100 mg/dL. If the cut off value of the baseline LDL-C was 74 mg/dL, then the sensitivity was 83% and the specificity was 50%. If the cut off value of the LDL-C within 2 weeks is 81 mg/dL, then the sensitivity was 83% and the specificity was 62%. ROC: receiver operating characteristics, LDL-C: low density lipoprotein-cholesterol.

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