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

• Published in: Scientific reports Vol. 13; no. 1; p. 10880
• Main Authors: Abe, Takuro, Shimazaki, Kensuke, Moriyama, Tetsu, Murohashi, Akira, Iwanami, Yuji, Sasaki, Akihito, Saito, Katsumi, Jujo, Kentaro
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.07.2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019/2776; 692/4019/592; 692/499; Angioplasty; Cardiovascular diseases; Cerebral infarction; Cholesterol; Cholesterol, LDL; Congestive heart failure; Coronary Angiography; Coronary Artery Disease - therapy; Coronary Stenosis - therapy; Fractional Flow Reserve, Myocardial; Humanities and Social Sciences; Humans; Ischemia; Low density lipoprotein; multidisciplinary; Myocardial infarction; Observational studies; Percutaneous Coronary Intervention; Science; Science (multidisciplinary); Stenosis; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-37988-z

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.