Optimal lipid-lowering therapy in patients who were functionally deferred percutaneous coronary intervention.

Abstract

Deferral of percutaneous coronary intervention (PCI) for functionally insignificant stenosis, defined as fractional flow reserve (FFR) > 0.80, is associated with favorable long-term prognoses. The lower-the-better strategy for low-density lipoprotein cholesterol (LDL-C) management is an established non-angioplasty therapy to improve the clinical outcomes of patients undergoing PCI. We examined the optimal LDL-C management in cases of intermediate coronary stenosis with deferred PCI on the basis of FFR values. This observational study included 273 consecutive patients with a single target vessel and deferred PCI with an FFR > 0.80. Patients with an FFR of 0.81-0.85 (n = 93) and those with FFR > 0.85 (n = 180) were classified into the lower (< 100 mg/dL) and higher (≥ 100 mg/dL) LDL-C groups. The endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including death, non-fatal myocardial infarction, ischemic stroke, heart failure hospitalization, and unplanned revascularization. Patients with an FFR of 0.81-0.85 had a significantly higher MACCE rate than those with an FFR > 0.85 (log-rank, p = 0.003). In patients with an FFR of 0.81-0.85, the lower LDL-C group showed a significantly lower MACCE rate than the higher LDL-C group (log-rank, p = 0.006). However, the event rate did not differ significantly between the two groups in patients with FFR > 0.85 (log-rank, p = 0.84). Uncontrolled LDL-C levels were associated with higher MACCE rates in cases with deferred PCI due to an FFR of 0.81-0.85. This high-risk population for adverse cardiovascular events should receive strict LDL-C-lowering therapy.

• Authors: Takuro Abe, Kensuke Shimazaki, Tetsu Moriyama, Akira Murohashi, Yuji Iwanami, Akihito Sasaki, Katsumi Saito, Kentaro Jujo
• Journal: Scientific reports (Sci Rep) Vol. 13 Issue 1 Pg. 10880 (07 05 2023) ISSN: 2045-2322 [Electronic] England
• PMID: 37407607 (Publication Type: Observational Study, Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• Cholesterol, LDL

Topics

• Humans
• Percutaneous Coronary Intervention
• Fractional Flow Reserve, Myocardial
• Cholesterol, LDL
• Treatment Outcome
• Coronary Stenosis (therapy)
• Coronary Angiography
• Coronary Artery Disease (therapy)