Association of Relative LDL-Cholesterol Reduction With Cardiovascular Outcomes After Percutaneous Coronary Intervention.

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.