Results suggest that better cholesterol management be considered after PCI
Higher low-density lipoprotein cholesterol (LDL-C) following percutaneous coronary intervention (PCI) is measured infrequently and associated with higher rates of cardiovascular death, myocardial infarction (MI), coronary revascularization, and stroke, a new study reports.
These findings suggest that better cholesterol management might be a consideration in post-PCI patients.
Patients who undergo PCI are at an increased risk of subsequent cardiovascular events in the long term. The majority of research efforts have focused on improving procedural and peri-procedural outcomes. Data on long-term optimization of patients post-PCI are lacking.
Maneesh Sud, MD, of the University of Toronto, and co-investigators, reported results from the CorHealth Ontario clinical cardiac registry that were published in the Sept. 22 issue of the Journal of the American College of Cardiology.
They identified 24,931 patients who underwent first-time PCI and had their LDL-C measured within 6 months post-PCI. Their primary outcome of interest was a composite of cardiovascular death, myocardial infarction (MI), coronary revascularization, and stroke. Patients were trichotomized on the basis of their post-PCI LDL-C (<70mg/dL, 70-100mg/dL and >100mg/dL).
Of the analyzed patients, only 57% had an LDL-C <70mg/dL. After a median follow-up of 3.2 years, rates of their primary composite outcome were 55.2/1,000 person-years in patients with an LDL-C <70mg/dL, 60.3/1,000 person-years in patients with an LDL-C of 70-100mg/dL, and 94.0/1,000 person-years in patients with an LDL-C >100mg/dL. The hazard ratio (HR) for this primary composite outcome of cardiovascular events was 1.17 (95% confidence interval [CI], 1.09-1.26) for an LDL-C between 70-100mg/dL and 1.78 (95% CI, 1.64-1.94) for an LDL-C above 100mg/dL compared with an LDL-C <70mg/dL.
Robert S. Rosenson, MD, of Icahn School of Medicine at Mount Sinai, New York, and co-authors, wrote an accompanying editorial to the study. They applaud the totality of the data presented in this study and note that adherence to high-intensity statin therapy remains a significant hurdle in the treatment of cardiovascular disease. They conclude that this large study provides important real-world evidence supporting aggressive and lower LDL-C targets in patients post-PCI.
Sud M, Han L, Koh M, et al. Low-Density Lipoprotein Cholesterol and Adverse Cardiovascular Events After Percutaneous Coronary Intervention. J Am Coll Cardiol 2020;76:1440-50.
Rosenson RS, Colantonio LD, Goonewardena SN. Optimizing Cholesterol Management Improves the Benefits of Percutaneous Coronary Intervention. J Am Coll Cardiol 2020;76:1451-4.