Long-term clinical impact of low-density lipoprotein cholesterol target attainment according to lesion complexity...

Area of Science:

• Cardiology
• Interventional Cardiology
• Lipid Metabolism

Background:

• Long-term outcomes of low-density lipoprotein cholesterol (LDL-C) target attainment after percutaneous coronary intervention (PCI) based on coronary lesion complexity are not well-established.
• Understanding these outcomes is crucial for optimizing patient management and risk stratification.

Purpose of the Study:

• To investigate the long-term clinical outcomes of LDL-C target attainment following PCI, specifically examining the influence of coronary lesion complexity.
• To determine if achieving LDL-C levels ≤70 mg/dl impacts major adverse cardiovascular events (MACE) differently in complex versus non-complex PCI.

Main Methods:

• A cohort of 1285 patients undergoing PCI was analyzed.
• Patients were categorized by LDL-C levels at 1 year (≤70 mg/dl vs. >70 mg/dl) and lesion complexity (complex vs. non-complex).
• The primary endpoint was MACE, defined as cardiac death, nonfatal myocardial infarction, and target vessel revascularization, assessed over an 8-year follow-up.

Main Results:

• At 8-year follow-up, patients achieving LDL-C ≤70 mg/dl had similar MACE incidence in the non-complex PCI group (8.3% vs. 11.6%, P=0.074).
• However, the complex PCI group with LDL-C ≤70 mg/dl showed significantly lower MACE incidence (11.7% vs. 19.2%, P=0.023).
• Inverse Probability of Treatment Weighting (IPTW) adjustment confirmed that LDL-C ≤70 mg/dl was associated with reduced MACE in both complex and non-complex PCI groups.

Conclusions:

• Attainment of LDL-C levels ≤70 mg/dl is associated with a reduced MACE rate in both complex and non-complex PCI scenarios.
• The long-term clinical benefits of achieving LDL-C targets are particularly prominent in patients who have undergone complex PCI.