Abstract
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.
Highlights
Different guidelines recommend different approaches to lipid management in patients with atherosclerotic cardiovascular disease
We examined a more stringent criteria, such that only patients who fulfilled criteria measured at both periods of 0–180 days and 181–365 days after percutaneous coronary intervention (PCI) were considered as criteria fulfillment, and repeated the analysis examining the outcomes occurring between 365 days and 5 yr
Between January 2004 and December 2017, a total of 36,346 patients were considered for inclusion, and 27,696 (76.2%) were excluded due to any of the following exclusion criteria: age younger than 18 yr, major adverse cardiac event (MACE) occurred within 365 days after PCI, orno available lipid profile within 365 days after PCI, or fulfilled neither target nor intensity criteria
Summary
Different guidelines recommend different approaches to lipid management in patients with atherosclerotic cardiovascular disease. Numerous randomized controlled trials (RCT) have established the pivotal role of 3-hydroxy3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) in cardiovascular risk reduction for patients with established coronary artery disease [2, 3]. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommended high intensity statin without specifying LDL-C targets for patients with established cardiovascular disease [4]. In the 2018 revision, the ACC/AHA conjoined with other American societies continued the class I recommendation for routine high-intensity statins, with options of adjunctive lipid-lowering therapy in selected subgroups [5]. The 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guideline recommended an LDL-C target of
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