Why the study?
Guidelines differ on lipid management approaches in atherosclerotic cardiovascular disease, leaving the optimal strategy unclear for Asian patients undergoing PCI.
Does high-intensity statin therapy reduce the composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization in Asian patients undergoing first-ever PCI compared to achieving LDL-C targets without high-intensity statins?
Does high-intensity statin therapy reduce the composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization in Asian patients undergoing first-ever PCI compared to achieving LDL-C targets without high-intensity statins?
In Asian patients post-PCI, high-intensity statin therapy is associated with a lower risk of major adverse cardiovascular events at 5 years compared to achieving LDL-C targets without high-intensity statins.
May support high-intensity statins post-PCI in Asians; leaves open need for RCTs to confirm causality over LDL-C targeting alone.
Background: Different guidelines recommend different approaches to lipid management in patients with atherosclerotic cardiovascular disease. We aim to determine the best strategy for lipid management in Asian patients undergoing percutaneous coronary intervention (PCI). Method: This was a retrospective cohort study conducted in patients who underwent first-ever PCI from 14 hospitals in Hong Kong. All participants either achieved low-density lipoprotein cholesterol (LDL-C) target of <55 mg/dl with ≥50% reduction from baseline (group 1), or received high-intensity statin (group 2), or both (group 3) within 1 yr after PCI. The primary endpoint was a composite outcome of all-cause mortality, myocardial infarction, stroke, and any unplanned coronary revascularization between 1 and 5 yr after PCI. Results: A total of 8,650 patients were analyzed with a median follow-up period of 4.2 yr. After the adjustment of baseline characteristics, complexity of PCI and medications prescribed and the risks of the primary outcome were significantly lower in group 2 (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.74–0.93, P = 0.003) and group 3 (HR, 0.75; 95% CI, 0.62–0.90; P = 0.002). The primary outcome occurred at similar rates between group 2 and group 3. Conclusions: Use of high intensity statin, with or without the attainment of guidelines recommended LDL-C target, was associated with a lower adjusted risk of MACE at 5 yr, compared with patients who attained LDL-C target without high intensity statin.
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Ng et al. (2021) studied this question.
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