The Effects of Hyperlipidemia and Lipid Levels on Coronary Flow, Microcirculation and Left Ventricular Systolic Function in Patients with Acute STEMI Undergoing Primary Coronary Intervention

Background: After primary percutaneous coronary angioplasty (PPCI), distal embolization with clot and atheroma material may reduce myocardial perfusion and thus may decrease myocardial salvage and result in reduced left ventricular systolic function.

Aim: Evaluation of coronary artery flow, myocardial perfusion and left ventricular systolic function after PPCI.

Methods: 162 patients with acute anterior ST-elevation myocardial infarction undergoing PPCI were studied. TIMI and myocardial blush (MBG) before and after PPCI, ST-elevation resolution, TTE-Doppler sampling of flow in the left anterior descending coronary artery (LAD), and assessment of left ventricular (LV) ejection fraction and wall motion score index (WMSI) of LV and LAD area early after PPCI and before discharge were measured.

Results: Patients without history of hyperlipidemia had lower frequency of hypertension, obesity, and known previous coronary artery disease, had greater extent and higher frequency of complete ST-elevation resolution, and better improvement in LV systolic function at discharge. While coronary and myocardial flow evaluations and LV systolic function were not affected by prior treatment for hyperlipidemia, this treatment was associated with a tendency of lower maximal troponin blood levels. Patients with cholesterol blood levels exceeding 240mg%, had higher frequency of absence of ST-elevation resolution after PPCI, however, LV systolic function was similar between the groups. Patients with low density lipoprotein levels exceeding 160mg% had higher maximal diastolic LAD velocity and integral at late evaluation, but LV systolic function was not affected by the level. Patients with high density lipoprotein more than 40mg% were older, with lower body weight, more heart failure at presentation and had higher creatinine phosphokinase levels. High triglyceride levels were not associated with reduction in LV systolic function.

Conclusions: After PPCI, hyperlipidemia is associated with reduced coronary and myocardial flow and with lower LV systolic function. Prior treatment of hyperlipidemia was associated with less myocardial damage after PPCI.