Low-density Lipoprotein Cholesterol Level on Admission and After One Year with Clinical Outcomes in Patients Admitted...

Percutaneous coronary intervention (PCI) is the established treatment for acute coronary syndromes (ACS). Despite optimal procedural outcomes with advanced hardware, recurrent coronary events within 1-year are known to occur. In-patients with documented ACS, the American College of Cardiology/American Heart Association recommends use of high intensity statins (which lowers low-density lipoprotein cholesterol (LDL-C) by ≥50%), i.e., 40-80 mg for atorvastatin though the European guidelines have recommended a LDL-C level of 1.4 mmol/l or below as a core preventative measure for future events.

The aim of the study is to find proportion of patients with European guideline recommended target of LDL-C <1.4 mmol/L during the first presentation of ACS, and after 1 year, and to correlate with 1-year clinical outcomes in patients undergoing PCI.

This is a retrospective observational study at a tertiary care referral hospital of ACS patients who underwent PCI from January 1, 2019, to December 31, 2019. A total of 371 patients were included in the study who had a baseline and 1-year lipid profile data. Patients were divided into two groups, LDL-C ≤1.4 mmol/L (Group 1) and more than 1.4 mmol/L (Group 2) and compared for major adverse cardiovascular events (MACE).

At presentation, 354 (95%) patients presented with LDL-C level above 1.4 mmol/L. Mean LDL-C level at presentation and at 1-year was high at 3.05 ± 1.11 and 2.36 ± 1.06 mmol/L, respectively. Majority of the patients were on atorvastatin 40 mg at discharge (77%). At 1 year, only 15% had LDL-C level below 1.4 mmol/L and 79% were still on 40 mg of atorvastatin. Overall, 51% of the cohorts were asymptomatic and 32% presented with MACE. Majority of MACE occurred in Group 2 80% of total MACE compared to 20% in Group 1. Unadjusted odds ratios for myocardial infarction, cardiac death, and target vessel revascularization by PCI in Group 2 were not significant. However, they were high for cerebrovascular accident (CVA) (4.4) and coronary artery bypass surgery (1.9). Seventy-two percent of patients had 50% reduction in their LDL-C from baseline but not reaching a goal of <1.4 mmol/L. However, there was statistically significant increase in CVA and cardiac death in patients with no 50% reduction (P < 0.05).

In a tertiary hospital large-volume ACS-PCI center, more than two-thirds of patients had their mean LDL-C level at presentation and 1-year beyond the recommended target level of <1.4 mmol/L, with one-third of patients developing 1-year MACE. A strategy of only taking a high-intensity statin was not adequate in reaching the LDL-C goal of <1.4 mmol/L though two-thirds of patient achieved 50% reduction in their LDL-C. There is an urgent need to educate physicians in the region to follow the recommended target LDL-C of 1.4 mmol/L and escalate the statin dose. In addition, there is a need to make availability of add-on anti-lipid drugs to attain this target and prevent MACE.