Abstract
Aim: Percutaneous coronary intervention (PCI) with a drug-coated balloon (DCB) is a coronary revascularization strategy; however, the prognostic impact of achieved low-density lipoprotein cholesterol (LDL-C) levels after intervention remains unclear. In this study, we aimed to understand the association between LDL-C and the clinical outcomes in patients undergoing PCI with DCB.
Methods: This single-center retrospective study included consecutive patients who underwent PCI with DCB (April 2019–March 2023) and had available 6-month LDL-C data. The clinical outcomes were assessed using a 6-month landmark approach. Patients were stratified by LDL-C level (＜70, 70–＜100, and ≥ 100 mg/dL). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, and target lesion revascularization (TLR).
Results: Among 320 patients, 47.8% had LDL-C ＜70 mg/dL, 31.6% had 70–＜100 mg/dL, and 20.6% had LDL-C ≥ 100 mg/dL. The cumulative incidence of MACE and TLR was significantly higher with increasing LDL-C levels (log-rank P = 0.006 and P = 0.023, respectively), whereas all-cause mortality and myocardial infarction did not differ significantly. In a multivariate Cox regression analysis, LDL-C ≥ 100 mg/dL independently predicted TLR (adjusted hazard ratio, 2.31; 95% confidence interval, 1.16–4.61; P = 0.02). In an exploratory subgroup analysis, PCSK9 inhibitor use was associated with lower achieved LDL-C levels and reduced rates of MACE and TLR.
Conclusions: Among patients undergoing PCI with DCB, higher achieved LDL-C levels, particularly LDL-C ≥ 100 mg/dL, were independently associated with an increased TLR risk, which primarily drove the observed difference in MACE. These findings highlight the importance of optimal LDL-C management following PCI with DCB.
