Impact of the attainment of current recommended low-density lipoprotein cholesterol goal of less than 70 mg/dl on clinical outcomes in very high-risk patients treated with drug-eluting stents.
OBJECTIVE
We sought to evaluate whether the attainment of low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dl would affect clinical outcomes in Korean patients treated with drug-eluting stents (DES).


BACKGROUND
The current cholesterol guideline has strongly recommended reducing LDL-C to less than 70 mg/dl as the goal of therapy for very high-risk patients.


METHODS
From 2003 to 2006, a total of 1347 very high-risk patients were treated with DES. Among them, we identified 578 eligible patients with follow-up LDL-C within 6-8 months after DES and divided these patients into two groups based on the level of follow-up LDL-C: group A, follow-up LDL less than 70 mg/dl (n=234) and group B, LDL of at least 70 mg/dl (n=344). Then we analyzed the incidence of major adverse cardiac and cerebrovascular events [MACCE: death, myocardial infarction, target-vessel revascularization (TVR), non-TVR, cerebrovascular accidents] of both the groups.


RESULTS
During the follow-up (mean duration=30+/-10 months), group A showed a significantly lower TVR (6%) and MACCE rate (14%), compared with group B (TVR: 12%, P=0.032; MACCE: 24%, P=0.002). However, there was no difference in the rate of death, myocardial infarction, or cerebrovascular accidents between the two groups. By multivariate analysis, follow-up LDL-C level of less than 70 mg/dl was one of the significant predictors for the occurrence of MACCE (odds ratio=0.39, 95% confidence interval: 0.21-0.72, P=0.003) or TVR (odds ratio=0.39, 95% confidence interval: 0.20-0.76, P=0.005).


CONCLUSIONS
This study showed that the attainment of LDL-C goal of less than 70 mg/dl was significantly associated with a lower MACCE or TVR rate in very high-risk Korean patients treated with DES.
Kim
Byeong-Keuk
BK
Cardiology Division, Cardiovascular Center of National Health Insurance Corporation Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
Kim
Dong Whan
DW
Oh
Seungjin
S
Yoon
Se-Jung
SJ
Park
Sungha
S
Jeon
Dong Woon
DW
Yang
Joo Young
JY
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D019983:Guideline Adherence; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents