Association between atherogenic index of plasma and in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention

Abstract

Aim: Dyslipidemia is an established risk factors for cardiovascular disease. Increased triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) levels, and decreased HDL-C levels were associated with increased cardiovascular risk. Recently, comprehensive lipid profile indices derived from these conventional parameters have attracted to attention. Atherogenic index of plasma (AIP) is one of the indices calculated as the logarithm of TG/HDL-C levels and, it is accepted as an alternative and simple marker of plasma atherogenicity. Although various studies demonstrated that their relationship with these lipid indices and clinical outcomes in patients with acute coronary syndrome, this situation is not yet clear in acute ST-elevation myocardial infarction (STEMI) patients undergoing primer percutaneous coronary intervention (pPCI). The aim of this study was to focus on the relationship traditional lipid levels and non-traditional comprehensive lipid indices and in hospital-mortality in patients with STEMI after pPCI. In this study, it is planned to investigate the relationship of AIP with early mortality in STEMI patients undergoing primary percutaneous coronary intervention.
 Material and Methods: In this retrospective, single center, hospital-based study, between January 2019 and April 2021, a total of 873 consecutive STEMI patients (705 men; median age 59 years), whose undergoing pPCI, are enrolled. The patients were divided into two groups according to in-hospital mortality status namely survivor and deceased. Conventional lipid values were measured and non-traditional lipid indexes including non-HDL-C [Total cholesterol minus HDL-C], Total cholesterol/HDL-C, LDL-C/HDL-C, atherogenic index (AI) [non-HDL-C/HDL-C], lipoprotein combine index (LCI) [Total cholesterol*TG*LDL-C/HDL-C] and atherogenic index of plasma (AIP) [Log(TG/HDL-C)] were calculated. Angiographic evaluations of the patients were performed through the hospital automation system. 
 Results: AIP was significantly higher in hospital mortality patients compared to survivor group (0.59, 0.47, p=0.006, respectively). AI, non-HDL-C, Total cholesterol/HDL-C ratio, LDL-C/HDL-C ratio and LCI measurements were similar between two groups. The cut-off value of the AIP (0.50) was associated with 70% sensitivity and 52% specificity for predicts in-hospital mortality. Multivariate logistic regression model yielded AIP (OR: 3.77, 95% CI: 1.34–10.6, p < 0.012) as independent predictor of in-hospital mortality.
 Conclusion: AIP predicts in-hospital mortality in patients with STEMI undergoing pPCI. AIP, which can be calculated easily from complete blood, can be beneficial in the prognostication of these patients.

The association of atherogenic index of plasma with cardiovascular outcomes in patients with coronary artery disease: A systematic review and meta-analysis

“…A significant heterogeneity was found for the no-reflow phenomenon (I 2 = 89.7%, P < 0.001). Three studies analyzed AIP as a continuous variable, which reported an of HR 1.21 (95% CI, 0.72–2.02, P = 0.460), 1.61 (95% CI, 1.12–2.32, P = 0.009), 3.77 (95% CI, 1.34–10.60, P = 0.012), and 13.46 (95%CI, 1.39-129.02; P = 0.025) for cardiovascular death [ 17 ], MI [ 17 ], all-causes death [ 21 ], and stent thrombosis [ 24 ], respectively.…”

“…However, Refs. [ 16 , 26 , 29 ]) considered AIP as a continuous variable, and found a significant positive correlation between AIP level and risk of all-causes mortality [ 21 ]. This discrepancy may be due to low number of studies and the differences in follow-up duration between the studies.…”