Abstract 16753: Effectiveness of Guideline-Endorsed Low-Density Lipoprotein Cholesterol Reduction Rates in Patients With Prior Percutaneous Coronary Intervention

Background/Objective: Low-density lipoprotein cholesterol (LCL-C) should be treated by guideline directed management which is more than 50% reduction of initial LDL-C and less than 55mg/dL LDL-C level in patients with prior percutaneous coronary intervention (PCI). However, there is no direct comparative evidence on target reduction rate and target goal LDL-C level. Therefore, we investigated the clinical influence of >50% reduction from baseline LDL-C in patients with prior PCI. Methods: A total of 3,104 patients with prior PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The primary endpoint was 3-year major adverse cardiovascular events (MACE which was defined as a composite of cardiovascular death, nonfatal myocardial infarction, target-lesion revascularization, hospitalization for heart failure, or non-fatal stroke. And the secondary endpoints were individual components of the primary endpoint. Results: Among all patients, the achievement rate of target LDL-C < 55 mg/dL and more than 50% reduction from baseline was 17.2%. There was no significant difference between the LDL < 55 mg/dL group and the LDL ≥ 55 mg/dL group in the risk for MACE (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.84-1.43; P = 0.502) after propensity score matching. However, the group that achieved ≥ 50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACE in the subgroup of LDL-C level ≥ 55 mg/dL (HR, 0.34; 95% CI, 0.16-0.74; P= 0.004), compared to the group with < 50% reduction of LDL-C. Conclusion: More than 50% reduction from the baseline LDL-C reduced the incidence of MACE in the LDL-C ≥ 55 mg/dL