Key result
Low admission LDL-C in statin-naïve STEMI is not independently linked to mortality after frailty adjustment.
Why the study?
Low admission LDL-C is paradoxically associated with worse outcomes after acute coronary syndrome, but whether this reflects confounding rather than causation in statin-naïve patients remained unclear.
Does low admission LDL-C (<100 mg/dL) independently predict higher all-cause mortality in statin-naïve patients with a first STEMI treated with primary PCI?
Population
388 statin-naïve patients with a first STEMI treated with primary PCI
Comparison
Admission LDL-C <100 vs 100–130 vs >130 mg/dL
Design
Observational cohort study
Follow-up
Up to five years
Authors
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Low admission LDL-C signals higher risk in statin-naïve STEMI patients; confirms the paradox persists independent of statin confounding.
Cohort (n=388)
Does low admission LDL-C (<100 mg/dL) independently predict higher all-cause mortality in statin-naïve patients with a first STEMI treated with primary PCI?
Hazard Ratio: 2.03 (95% CI 1.02–4.03)
p-value: p=0.014
The 'lipid paradox' (higher mortality with lower LDL-C) in statin-naïve STEMI patients is driven by confounding factors like age and frailty rather than a protective effect of higher LDL-C.
Akkaya et al. (2026) conducted a cohort in First ST-segment elevation myocardial infarction (STEMI) (n=388). Low admission LDL-C (<100 mg/dL) vs. Higher admission LDL-C (100-130, >130 mg/dL) was evaluated on All-cause mortality (HR 2.03, 95% CI 1.02-4.03, p=0.014). Low admission LDL-C (<100 mg/dL) in statin-naïve STEMI patients was associated with higher crude mortality, but became non-significant after adjustment for age and frailty (adjusted HR 1.27-1.43).
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