Abstract
Aim: Intensive low-density lipoprotein cholesterol (LDL-C) lowering is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI). Although most evidence has focused on achieved LDL-C levels, the prognostic significance of relative LDL-C reduction has been less well characterized. The joint influence of achieved LDL-C levels and relative reduction in real-world PCI populations remains unclear.
Methods: We retrospectively analyzed consecutive patients who underwent PCI between 2006 and 2016 at a single tertiary center. Relative LDL-C reduction was calculated from baseline and follow-up measurements. The primary outcome was three-point major adverse cardiovascular events plus any coronary revascularization. Cox proportional hazards models with restricted cubic splines were used to assess continuous dose–response relationships. Secondary analyses evaluated categorical thresholds of relative LDL-C reduction (＜30%, 30–49%, ≥50%) and achieved LDL-C ＜55 mg/dL. A thin-plate spline generalized additive model was used to visualize their joint association with cardiovascular risk.
Results: Among 809 patients, greater relative LDL-C reduction was associated with a significantly lower risk of the primary outcome in a nonlinear pattern (overall P = 0.0001; nonlinearity P = 0.0007). Compared with ＜30% reduction, 30–49% and ≥ 50% reductions were associated with progressively lower risk. Achieved LDL-C ＜55 mg/dL was associated with lower risk, and the most favorable outcomes were observed when low achieved LDL-C levels were accompanied by substantial relative LDL-C reduction.
Conclusion: Relative LDL-C reduction provides clinically meaningful prognostic information after PCI, complementing achieved LDL-C levels and supporting guideline-based lipid-lowering strategies.
