TCT-765 Lipid-Lowering Therapy in Contemporary PCI Practice

Abstract

Background
Patients with coronary artery disease (CAD) face high risks for recurrent events, especially within the first year after myocardial infarction or coronary revascularization. Historically, achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets is challenging.
Methods
In this prospective observational cohort study from 2 ongoing PCI trials (NCT04923191 and NCT04390672), we investigated lipid-lowering therapy (LLT) use during the first year after contemporary percutaneous coronary intervention (PCI). Machine learning facilitated logistic regression identified predictors of LLT intensification.
Results
LLT regimens were intensified in about one-third of patients, primarily by adding ezetimibe to statin therapy (Table 1). Of concern, 7.2%-8.8% of patients received no LLT, and only 2% were on PCSK9 inhibitors. Preprocedural country of treatment, age, and LDL-C levels were significant predictors of LLT intensification, with baseline LDL-C being the strongest predictor (Figure 1; OR: 6.36; P < 0.001; C-index = 0.711).

Lipid-Lowering Regimen at Baseline Lipid-Lowering Regimen at 12 Months
No Lipid-Lowering Therapy Statin Monotherapy Statin Plus Ezetimibe Total
No lipid-lowering therapy 36 (2.9) 139 (11.4) 57 (4.7) 232 (19)
Statin monotherapy 39 (3.2) 627 (51.2) 202 (16.5) 868 (70.9)
Statin plus ezetimibe 2 (0.2) 9 (0.7) 112 (9.2) 124 (10.1)
Total 77 (6.3) 775 (63.3) 372 (30.4) 1,224 (100)

Values are n (%). 32% (398/1,224) patients hadintensification in LLT in the first year. 4% (50/1,224) patients had deintensification in LLT in the first year. 63% (776/1,224) patients had no change in LLT in the first year, with the majority (81%) staying on statin monotherapy.
Conclusions
Preprocedural LDL-C levels strongly predict LLT intensification within the first year after PCI. With approximately 8% of patients receiving no LLT, directly prescribing high-intensity statins plus ezetimibe after PCI could bridge the gap and mitigate early residual risk.