Achieving LDL-C <1.0 mmol/L and cardiovascular outcomes in patients with coronary artery disease who received percutaneous coronary intervention.

Abstract

BACKGROUND AND AIMS: The ESC guideline recommends LDL-C<1.0 mmol/L in extreme-risk patients. However, recent clinical trials demonstrated cardiovascular benefits with achieving very low LDL-C levels even in very high-risk patients including patients with CAD. Patients with CAD may more benefit from lowering LDL-C<1.0 mmol/L rather than their guideline-recommended LDL-C goal (<1.4 mmol/L). METHOD(S): The current multi-center observational study analyzed 2560 patients with CAD receiving PCI (2017.1.1-2022.8.31). All of study participants were clinically followed for at least three years after PCI. The primary (cardiac death, non-fatal MI and clinically-driven coronary revascularization at non-culprit segments) and secondary outcomes (cardiac death, non-fatal MI) were compared in those stratified according to on-treatment LDL-C levels at 2 months after PCI (<1.0, 1.0-1.3 and >= 1.4 mmol/L). RESULT(S): On-treatment LDL-C<1.0 mmol/L was achieved in 9.8% (=251/2560) of study participants. In extreme-risk patients exhibiting the concomitance of polyvascular disease or a history of recurrent ASCVD, the proportions of LDL-C<1.0 mmol/L were 10.5 and 9.6%, respectively. More intensified lipid-lowering therapies were used in those with on-treatment LDL-C<1.0 mmol/L (high-intensity statin = 77.7%, p < 0.001; ezetimibe = 67.3%, p < 0.001; PCSK9-I = 13.9%, p < 0.001). During the observational perid (median = 1882 days), achieving on-treatment LDL-C<1.0 mmol/L significantly reduced risks of primary (adjusted HR = 0.23, 95%CI = 0.11-0.48, p < 0.001) and secondary outcomes (adjusted HR = 0.31, 95%CI = 0.11-0.84, p = 0.022). These benefits were consistently observed regardless of age, gender, types of CAD and various traditional risk factors. CONCLUSION(S): Achieving LDL-C<1.0 mmol/L mitigated risks of subsequent atherosclerotic cardiovascular events in patients with CAD. More actions are needed to further promote the intensification of lipid-lowering therapies in patients with CAD.Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.