Why the study?
There is little direct comparative evidence on the clinical impact of LDL-C strategies between achieving ≥50% reduction and absolute target LDL-C <55 mg/100 ml in patients after PCI.
Does achieving LDL-C <55 mg/100 ml or ≥50% reduction from baseline reduce 3-year MACEs in patients who underwent PCI?
Cohort (n=3,104)
No
Does achieving LDL-C <55 mg/100 ml or ≥50% reduction from baseline reduce 3-year MACEs in patients who underwent PCI?
Hazard Ratio: 1.06 (95% CI 0.81–1.38)
p-value: p=0.690
Achieving a ≥50% reduction in LDL-C from baseline significantly reduces 3-year MACEs in post-PCI patients who do not reach the absolute target of <55 mg/dL.
There are little direct comparative evidences of strategies between ≥50% and the absolute target goal of low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml for the patients who underwent percutaneous coronary intervention (PCI). This study aimed to investigate the clinical impact of different strategies between 2 groups of patients who underwent PCI. A total of 3,104 patients with previous PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The study population was stratified into 2 groups based on whether the LDL-C level was <55 mg/100 ml at the 1-year mark or not. Furthermore, the 50% reduction rate of LDL-C was also categorized based on whether it had decreased by ≥50% from the initial LDL-C level at the 1-year mark. The primary end point was 3-year major adverse cardiovascular events (MACEs) which were defined as a composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization, hospitalization for heart failure, or nonfatal stroke. There was no significant difference between the LDL <55 mg/100 ml group and the LDL ≥55 mg/100 ml group in the risk of MACEs (hazard ratio 1.06, 95% confidence interval 0.81 to 1.38, p = 0.690) after propensity score matching. However, the group that achieved ≥50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACEs in the subgroup of LDL-C level ≥55 mg/100 ml (hazard ratio 0.41, 95% confidence interval 0.19 to 0.89, p = 0.025) compared with the group with <50% reduction of LDL-C. In all patients, the achievement rate of target LDL-C <55 mg/100 ml and more than 50% reduction from baseline was 17.2%. In conclusion, guideline-directed management strategy of ≥50% reduction of LDL-C from the baseline will be needed to reduce the incidence of MACEs in patients with LDL-C ≥55 mg/100 ml who underwent PCI. Additional efforts to increase the target goal achievement rate of LDL-C are warranted.
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Park et al. (2023) conducted a cohort in Percutaneous coronary intervention (PCI) (n=3,104). LDL-C level <55 mg/100 ml at 1 year vs. LDL-C level ≥55 mg/100 ml at 1 year was evaluated on 3-year major adverse cardiovascular events (MACEs) (composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization, hospitalization for heart failure, or nonfatal stroke) (HR 1.06, 95% CI 0.81 to 1.38, p=0.690).
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