Treat-to-target lipid control is effective but highlighted poor prognosis without indication of statin following percutaneous coronary intervention.

Abstract

A reduction of low-density lipoprotein cholesterol (LDL-C) is important for the secondary prevention of coronary artery disease. We performed secondary prevention in 632 consecutive patients, including 315 with acute coronary syndrome, who underwent percutaneous coronary intervention according to current treat-to-target lipid-lowering guidelines to achieve LDL-C<100mg/dL. We retrospectively analyzed 2-year all-cause mortality. The average LDL-C level was reduced from 114±36mg/dL at baseline to 94±25mg/dL at follow-up; 61% of patients achieved the guideline target. Statin was not prescribed for 42 (6.6%) patients, with reasons mainly due to a low baseline LDL-C level, however, renal failure, an older age, stable coronary artery disease and having a female gender were also related factors. At the end of follow-up (average 2.0±0.9years), 90% of patients were on statins and showed a lower 2-year mortality rate than those not on statins (3.3 vs. 20.5%, p<0.001). In contrast, achieving LDL-C target levels did not impact mortality (4.9 vs. 4.8%, p=0.99). Propensity score matching analysis revealed statin use to be a predictor of better survival (p=0.009) after adjusting for a baseline difference between statin and no statin groups. A multivariable Cox proportional hazard showed that age (HR=1.12, 95% CI 1.03-1.22) and statin use (HR=0.14, 95% CI 0.008-0.77) were predictors of survival. Statin use was a significant predictor of improved mortality rates under treat-to-target guidelines. However, it also highlighted a poor prognosis in patients without an indication for statins.