Author + information
- Received May 13, 2020
- Revision received July 15, 2020
- Accepted July 15, 2020
- Published online September 14, 2020.
- Maneesh Sud, MDa,b,c,d,
- Lu Han, PhDc,
- Maria Koh, MScc,
- Husam Abdel-Qadir, MD, PhDb,c,d,e,f,g,
- Peter C. Austin, PhDb,c,
- Michael E. Farkouh, MD, MScd,e,g,
- Lucas C. Godoy, MDb,c,e,h,
- Patrick R. Lawler, MD, MPHd,e,g,
- Jacob A. Udell, MD, MPHb,c,d,e,f,g,
- Harindra C. Wijeysundera, MD, PhDa,b,c,d and
- Dennis T. Ko, MD, MSca,b,c,d,∗ ()
- aSchulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- bInstitute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- cICES, Toronto, Ontario, Canada
- dDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada
- ePeter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- fWomen’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- gTed Roger’s Centre for Heart Research, Toronto, Ontario, Canada
- hInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- ↵∗Address for correspondence:
Dr. Dennis T. Ko, ICES, 2075 Bayview Avenue, G106, Toronto, Ontario M4N 3M5, Canada.
Background After percutaneous coronary interventions (PCIs), patients remain at high risk of developing late cardiovascular events. Although controlling low-density lipoprotein cholesterol (LDL-C) may improve outcomes after PCI, practice guidelines do not have specific recommendations on LDL-C management for this subgroup.
Objectives The purpose of this study was to evaluate LDL-C testing and levels after PCIs, and to assess the association between LDL-C and longer-term cardiovascular events after PCIs.
Methods All patients who received their first PCI from October 1, 2011, to September 30, 2014, in Ontario, Canada, were considered for inclusion. Patients who had LDL-C measurement within 6 months after PCI were categorized as: <70 mg/dl, 70 to <100 mg/dl, and ≥100 mg/dl. The primary composite outcome was cardiovascular death, myocardial infarction, coronary revascularization, and stroke through December 31, 2016.
Results Among 47,884 included patients, 52% had LDL-C measured within 6 months of PCI and 57% had LDL-C <70 mg/dl. After a median 3.2 years, the rates of cardiovascular events were 55.2/1,000 person-years for the LDL-C <70 mg/dl group, 60.3/1,000 person-years for 70 to <100 mg/dl, and 94.0/1,000 person-years for ≥100 mg/dl. The adjusted subdistribution hazard ratios for cardiovascular events were 1.17 (95% confidence interval: 1.09 to 1.26) for LDL-C of 70 to <100 mg/dl, and 1.78 (95% confidence interval: 1.64 to 1.94) for LDL-C ≥100 mg/dl when compared with LDL-C <70 mg/dl.
Conclusions One in 2 patients had LDL-C measured within 6 months after PCI, and only 57% had LDL-C <70 mg/dl. Higher levels of LDL-C were associated with an increased incidence of late cardiovascular events. Improved cholesterol management after PCI should be considered to improve the outcomes of these patients.
- acute coronary syndromes
- low-density lipoprotein cholesterol
- percutaneous coronary intervention
- secondary prevention
- stable coronary artery disease
This study was funded by a Foundation grant (FDN-154333) from the Canadian Institutes of Health Research. This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources. No endorsement by ICES, or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. Dr. Sud is funded by the Eliot Phillipson Clinician-Scientist Program at the University of Toronto and by a Canadian Institute of Health Research Post-Doctoral Fellowship. Dr. Abdel-Qadir has received consultant fees from Amgen; and has received fees for endpoint adjudication committee membership for the THEMIS trial funded by AstraZeneca research grants. Drs. Austin and Ko are supported by Mid-Career Investigator Awards from the Heart and Stroke Foundation, Ontario Provincial Office. Dr. Farkouh has received research grants from Amgen, Novartis, and NovoNordisk. Dr. Udell has received consulting or speaker honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Merck, Novartis, and Sanofi; and has received research grants to his institution from AstraZeneca, Novartis, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received May 13, 2020.
- Revision received July 15, 2020.
- Accepted July 15, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.