High LDL-C levels up incidence of cardiovascular events after PCI

Increased levels of low-density lipoprotein cholesterol (LDL-C) appear to boost the incidence of late cardiovascular events following percutaneous coronary intervention (PCI), a study has found.

“After PCIs, patients remain at high risk of developing late cardiovascular events,” the investigators said. “Although controlling LDL-C may improve outcomes after PCI, practice guidelines do not have specific recommendations on LDL-C management for this subgroup.”

This study evaluated LDL-C testing and levels after PCIs, as well as the association between LDL-C and longer-term cardiovascular events after PCIs. The investigators included all patients who received their first PCI from 1 October 2011 to 30 September 2014 in Ontario, Canada. Patients who had their LDL-C measured within 6 months after PCI were categorized as follows: <70, 70 to <100, and ≥100 mg/dl.

The primary endpoint was a composite of cardiovascular death, myocardial infarction, coronary revascularization, and stroke through 31 December 2016.

A total of 47,884 patients were included, of whom 52 percent had LDL-C measurement within 6 months of PCI and 57 percent had LDL-C <70 mg/dl.

The rates of cardiovascular events after a median 3.2 years stood at 55.2 per 1,000 person-years for the LDL-C <70 mg/dl group, 60.3 per 1,000 person-years for the 70 to <100 mg/dl group, and 94.0 per 1,000 person-years for the ≥100 mg/dl group.

Compared with LDL-C <70 mg/dl, the adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95 percent confidence [CI], 1.09–1.26) for 70 to <100 mg/dl and 1.78 (95 percent CI, 1.64–1.94) for ≥100 mg/dl.

“Improved cholesterol management after PCI should be considered to improve the outcomes of these patients,” the investigators said.