International journal of cardiology. Heart & vasculature · 2026
Lipid-lowering therapy omission at discharge and one-year outcomes after percutaneous coronary intervention: a real-world analysis of overall and elderly patients.
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Peeters Denise A M, Woelders Eva C I, Janssen Sanne, Azzahhafi Jaouad, Chan Pin Yin Dean R P P, van den Broek Wout W A, van de Pol Qiu Ying F, Cetinyurek-Yavuz Aysun, Winkler Patty J C, Damman Peter, Luijkx Jasper J P, Remkes Wouter S, Van't Hof Arnoud W J, Ten Berg Jurriën M, van Geuns Robert Jan M
Аннотация
BACKGROUND: Lipid-lowering therapy (LLT) is recommended in all patients undergoing percutaneous coronary intervention (PCI), but its prescription remains suboptimal. Omission of LLT, particularly in elderly patients, is less well studied. We investigated the prevalence of LLT omission and its association with one-year major adverse cardiovascular and cerebral events (MACCE) in a real-world ACS population, with prespecified focus on elderly through a subgroup analysis.
METHODS: Data from the South-east Netherlands Heart Registry (ZON-HR) were merged with the Future Optimal Research and Care Evaluation (FORCE) ACS registry. ACS patients undergoing PCI with known discharge medication and one-year follow-up were included. Associations between LLT prescription at discharge and MACCE, individual components and all-cause death were compared with cox proportional hazard models.
RESULTS: Of 9.495 patients (mean age 65.8, 73.2% male), 720 (7.6%) did not receive LLT. In the elderly population (≥70) this was even higher (10%). Patients without LLT had a higher burden of risk factors. At one year, LLT omission was associated with a higher hazard of MACCE (adjusted HR = 2.70, 95%CI: 2.29-3.18). A comparable association was observed in elderly (adjusted HR of 2.70, 95%CI: 2.18-3.34). Absolute event rates were higher in elderly compared with younger patients (11.4% vs. 7.1%, p < 0.001).
CONCLUSION: In this real-world ACS population, omission of LLT at discharge was common and associated with higher rates of MACCE at one year. While relative associations were similar across age groups, elderly patients experienced higher absolute event rates. These findings may reflect both gaps in care and underlying patient vulnerability.
METHODS: Data from the South-east Netherlands Heart Registry (ZON-HR) were merged with the Future Optimal Research and Care Evaluation (FORCE) ACS registry. ACS patients undergoing PCI with known discharge medication and one-year follow-up were included. Associations between LLT prescription at discharge and MACCE, individual components and all-cause death were compared with cox proportional hazard models.
RESULTS: Of 9.495 patients (mean age 65.8, 73.2% male), 720 (7.6%) did not receive LLT. In the elderly population (≥70) this was even higher (10%). Patients without LLT had a higher burden of risk factors. At one year, LLT omission was associated with a higher hazard of MACCE (adjusted HR = 2.70, 95%CI: 2.29-3.18). A comparable association was observed in elderly (adjusted HR of 2.70, 95%CI: 2.18-3.34). Absolute event rates were higher in elderly compared with younger patients (11.4% vs. 7.1%, p < 0.001).
CONCLUSION: In this real-world ACS population, omission of LLT at discharge was common and associated with higher rates of MACCE at one year. While relative associations were similar across age groups, elderly patients experienced higher absolute event rates. These findings may reflect both gaps in care and underlying patient vulnerability.