Key result
LDL-C <1.0 mmol/L linked to ~77% fewer major cardiac events after PCI.
Why the study?
Does achieving on-treatment LDL-C <1.0 mmol/L reduce the risk of cardiovascular events in patients with coronary artery disease who received percutaneous coronary intervention?
Observational (n=2,560)
Yes
Does achieving on-treatment LDL-C <1.0 mmol/L reduce the risk of cardiovascular events in patients with coronary artery disease who received percutaneous coronary intervention?
Achieving very low LDL-C levels (<1.0 mmol/L) after PCI is associated with a significantly reduced risk of subsequent atherosclerotic cardiovascular events compared to higher LDL-C levels.
Abstract Background and aims The ESC guideline recommends LDL-C<1.0 mmol/L in extreme-risk patients. However, recent clinical trials demonstrated cardiovascular benefits with achieving very low LDL-C levels even in very high-risk patients including patients with CAD. Patients with CAD may more benefit from lowering LDL-C<1.0 mmol/L rather than their guideline-recommended LDL-C goal (<1.4 mmol/L). Methods The current multi-center observational study analyzed 2560 patients with CAD receiving PCI (2017.1.1-2022.8.31). All of study participants were clinically followed for at least three years after PCI. The primary (cardiac death, non-fatal MI and clinically-driven coronary revascularization at non-culprit segments) and secondary outcomes (cardiac death, non-fatal MI) were compared in those stratified according to on-treatment LDL-C levels at 2 months after PCI (<1.0, 1.0-1.3 and ≥ 1.4 mmol/L). Results On-treatment LDL-C<1.0 mmol/L was achieved in 9.8% (=251/2560) of study participants. In extreme-risk patients exhibiting the concomitance of polyvascular disease or a history of recurrent ASCVD, the proportions of LDL-C<1.0 mmol/L were 10.5 and 9.6%, respectively. More intensified lipid-lowering therapies were used in those with on-treatment LDL-C<1.0 mmol/L (high-intensity statin = 77.7%, p < 0.001; ezetimibe = 67.3%, p < 0.001; PCSK9–I = 13.9%, p < 0.001). During the observational perid (median = 1882 days), achieving on-treatment LDL-C<1.0 mmol/L significantly reduced risks of primary (adjusted HR = 0.23, 95%CI = 0.11-0.48, p < 0.001) and secondary outcomes (adjusted HR = 0.31, 95%CI = 0.11-0.84, p = 0.022). These benefits were consistently observed regardless of age, gender, types of CAD and various traditional risk factors. Conclusions Achieving LDL-C<1.0 mmol/L mitigated risks of subsequent atherosclerotic cardiovascular events in patients with CAD. More actions are needed to further promote the intensification of lipid-lowering therapies in patients with CAD.
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Kataoka et al. (2026) conducted an observational in Coronary artery disease (CAD) receiving percutaneous coronary intervention (PCI) (n=2,560). Achieving on-treatment LDL-C <1.0 mmol/L vs. Higher on-treatment LDL-C levels (1.0-1.3 and ≥ 1.4 mmol/L) was evaluated on Cardiac death, non-fatal MI and clinically-driven coronary revascularization at non-culprit segments (adjusted HR 0.23, 95% CI 0.11-0.48, p=< 0.001). Achieving on-treatment LDL-C <1.0 mmol/L significantly reduced the risk of cardiac death, non-fatal MI, and clinically-driven coronary revascularization (HR 0.23; 95% CI 0.11-0.48; P<0.001).
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