Impact of intensively lowered low-density lipoprotein cholesterol on deferred lesion prognosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Lipid Metabolism

Background:

• Lowering low-density lipoprotein cholesterol (LDL-C) is linked to reduced cardiovascular events.
• The impact of LDL-C reduction on the prognosis of deferred lesions after fractional flow reserve (FFR)-guided revascularization deferral remains underexplored.

Purpose of the Study:

• To assess the effect of intensively lowered LDL-C levels on the long-term outcomes of coronary lesions initially deferred from revascularization based on FFR.
• To determine if achieving an LDL-C level below 70 mg/dL influences the rate of deferred lesion failure (DLF).

Main Methods:

• A retrospective analysis of 192 patients with stable coronary artery disease and deferred lesions (FFR > 0.80).
• Patients were stratified into a LOW LDL-C group (<70 mg/dL) and a HIGH LDL-C group (≥70 mg/dL) based on first follow-up levels.
• Deferred lesion failure (DLF) was defined as composite of revascularization or myocardial infarction of the deferred lesion.

Main Results:

• The LOW LDL-C group (n=61) experienced significantly lower DLF rates (1.6%) compared to the HIGH LDL-C group (n=131) (10.7%) over a median 2.8-year follow-up (log-rank p = .043).
• Unplanned revascularization rates were also substantially lower in the LOW LDL-C group (3.3%) versus the HIGH LDL-C group (14.5%) (log-rank p = .032).

Conclusions:

• Achieving LDL-C levels below 70 mg/dL is associated with a significantly reduced incidence of deferred lesion failure.
• Intensive LDL-C lowering appears beneficial for the long-term prognosis of coronary lesions managed conservatively after FFR assessment.