High-Intensity Lipid-Lowering Therapy After Complex Percutaneous Coronary Intervention

We aimed to evaluate the association between high-intensity lipid-lowering therapy (HILLT) and long-term outcomes after percutaneous coronary intervention (PCI) across procedural complexity.

Post hoc observational cohort analysis of 3 drug-eluting stent registries (HOST-Onyx, HOST-Synergy, HOST-Alpine) was conducted. A total of 1,750 patients underwent PCI; 691 (39.5%) met criteria for complex PCI, defined as treatment of ≥3 stents implanted, ≥3 lesions treated, total stent length ≥60 mm, left main PCI, bifurcation PCI, or heavy calcification. The HILLT group was defined as those prescribed either high-intensity statins with or without ezetimibe, or moderate-intensity statins with ezetimibe. The primary outcome was major adverse cardio-cerebrovascular events (MACCE), composite of cardiac death, myocardial infarct, and stroke at 3 years. Multivariable Cox regression, propensity score (PS) matching, and inverse probability treatment weighting (IPTW) were used to adjust for confounding.

Patients receiving HILLT exhibited a lower risk of MACCE (PS-matched hazard ratio [HR], 0.508; 95% confidence interval [CI], 0.260-0.994; p=0.048). Subgroup analysis revealed that this benefit was significant among patients undergoing complex PCI (HR, 0.292; 95% CI, 0.107-0.797; p=0.017) compared with the noncomplex PCI group (HR, 0.896; 95% CI, 0.346-2.322; p=0.822; p-for-interaction=0.107). Sensitivity analyses in the complex PCI subgroup demonstrated consistent results, with lower risk of MACCE in patients receiving HILLT (PS-matched HR, 0.320; 95% CI, 0.116-0.881; p=0.027; IPTW-adjusted HR, 0.246; 95% CI, 0.093-0.647; p=0.004).

Among patients undergoing PCI, HILLT was associated with a lower 3-year risk of MACCE, with no significant interaction across procedural complexity.