Low-Density Lipoprotein Cholesterol and Adverse Cardiovascular Events After Percutaneous Coronary Intervention
Key result
Post-PCI LDL-C ≥100 mg/dl linked to ~78% higher cardiovascular event risk versus <70 mg/dl.
- HR 1.78
- 95% CI 1.64-1.94
- n=47,884
Why the study?
Patients remain at high risk of late cardiovascular events after PCI, but practice guidelines lack specific recommendations on LDL-C management for this subgroup.
Key Points
- To assess the frequency of LDL-C testing and post-procedure cholesterol levels, and evaluate their relationship with long-term adverse cardiovascular events in patients following percutaneous coronary intervention.
- Population-based cohort study of N=47,884 patients receiving their first percutaneous coronary intervention between October 1, 2011, and September 30, 2014, in Ontario, Canada.
- Patients with LDL-C measured within 6 months post-procedure were categorized (<70 mg/dl, 70 to <100 mg/dl, and ≥100 mg/dl) and followed for a median of 3.2 years through December 31, 2016, for a primary composite outcome of cardiovascular death, myocardial infarction, coronary revascularization, and stroke.
- Only 52% of patients had LDL-C measured within 6 months post-procedure, and 57% of those tested had LDL-C <70 mg/dl.
- Composite cardiovascular event rates were 55.2 per 1,000 person-years for LDL-C <70 mg/dl, 60.3 per 1,000 person-years for 70 to <100 mg/dl, and 94.0 per 1,000 person-years for ≥100 mg/dl.
- Adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95% CI: 1.09 to 1.26) for LDL-C 70 to <100 mg/dl and 1.78 (95% CI: 1.64 to 1.94) for LDL-C ≥100 mg/dl compared to LDL-C <70 mg/dl.
Study Design
Type
Cohort (n=47,884)
Multicenter
Yes
PICO
P
Population
47,884 patients who received their first PCI in Ontario, Canada, followed for a median of 3.2 years to assess the association between post-PCI LDL-C levels and cardiovascular events.
E
Exposure / Comparator
LDL-C ≥100 mg/dl vs LDL-C <70 mg/dl
O
Primary Outcome
cardiovascular death, myocardial infarction, coronary revascularization, and stroke — HR 1.78 (1.64-1.94)
Main Result
Hazard Ratio: 1.78 (95% CI 1.64–1.94)
Absolute Event Rate: 94% vs 55.2%
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Only 50% of people in the USA have their LDL level checked within six months of a PCI for stable coronary disease, much less with medication optimisation.”
“I think this is important and it behoves us that, as great as our interventions and our tools are, they are not going to be great in avoiding and averting events in non-target lesions or anywhere else. So, to make our interventions durable, we have to pair it with prevention.”
Implication
Cohort study reveals higher LDL cholesterol levels increase cardiovascular events after percutaneous coronary intervention, highlighting the critical need for post-procedure lipid management.
Abstract
BACKGROUND After percutaneous coronary interventions (PCIs), patients remain at high risk of developing late cardiovascular events. Although controlling low-density lipoprotein cholesterol (LDL-C) may improve outcomes after PCI, practice guidelines do not have specific recommendations on LDL-C management for this subgroup. OBJECTIVES The purpose of this study was to evaluate LDL-C testing and levels after PCIs, and to assess the association between LDL-C and longer-term cardiovascular events after PCIs. METHODS All patients who received their first PCI from October 1, 2011, to September 30, 2014, in Ontario, Canada, were considered for inclusion. Patients who had LDL-C measurement within 6 months after PCI were categorized as: <70 mg/dl, 70 to <100 mg/dl, and ≥100 mg/dl. The primary composite outcome was cardiovascular death, myocardial infarction, coronary revascularization, and stroke through December 31, 2016. RESULTS Among 47,884 included patients, 52% had LDL-C measured within 6 months of PCI and 57% had LDL-C <70 mg/dl. After a median 3.2 years, the rates of cardiovascular events were 55.2/1,000 person-years for the LDL-C <70 mg/dl group, 60.3/1,000 person-years for 70 to <100 mg/dl, and 94.0/1,000 person-years for ≥100 mg/dl. The adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95% confidence interval: 1.09 to 1.26) for LDL-C of 70 to <100 mg/dl, and 1.78 (95% confidence interval: 1.64 to 1.94) for LDL-C ≥100 mg/dl when compared with LDL-C <70 mg/dl. CONCLUSIONS One in 2 patients had LDL-C measured within 6 months after PCI, and only 57% had LDL-C <70 mg/dl. Higher levels of LDL-C were associated with an increased incidence of late cardiovascular events. Improved cholesterol management after PCI should be considered to improve the outcomes of these patients.
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Cite This Study
Sud et al. (2020) conducted a cohort in Post-percutaneous coronary intervention (n=47,884). LDL-C ≥100 mg/dl vs. LDL-C <70 mg/dl was evaluated on cardiovascular death, myocardial infarction, coronary revascularization, and stroke (HR 1.78, 95% CI 1.64-1.94). Compared with LDL-C <70 mg/dl, LDL-C ≥100 mg/dl after PCI was associated with a higher rate of cardiovascular events (94.0 vs 55.2 per 1,000 person-years; HR 1.78, 95% CI 1.64-1.94).