Impact of intensively lowered low‐density lipoprotein cholesterol on deferred lesion prognosis

Abstract

Objectives The aim of this study was to investigate the impact of intensively lowered low‐density lipoprotein cholesterol (LDL‐C) level on the deferred lesion prognosis after revascularization deferral based on fractional flow reserve (FFR). Background Lowering LDL‐C is associated with lower cardiovascular event rate, but its benefit on the deferred lesion prognosis has not been well evaluated. Methods This retrospective, single‐center, observational study analyzed 192 deferred lesions with FFR value >0.80 in 192 patients with stable coronary artery disease. According to the first follow‐up LDL‐C level, they were assigned to the LOW group (<70 mg/dL) or the HIGH group (≥70 mg/dL). Deferred lesion failure (DLF) was defined as the composite of deferred lesion revascularization and deferred vessel myocardial infarction. Results Of all participants, 61 and 131 patients were assigned to the LOW and the HIGH group, respectively. During the median follow‐up of 2.8 years, DLF occurred in 1 and 14 patients in the LOW group and the HIGH group (1.6% and 10.7%, log‐rank p = .043), respectively. The incidence of any unplanned revascularization was also significantly lower in the LOW group than in the HIGH group (3.3% vs. 14.5%, log‐rank p = .032). Conclusions The incidence of DLF was significantly lower in the patients with LDL‐C < 70 mg/dL than in those with LDL‐C ≥ 70 mg/dL at the first follow‐up after FFR‐based deferral of revascularization.

Optimal lipid-lowering therapy in patients who were functionally deferred percutaneous coronary intervention

“…All patients with intermediate coronary stenosis, which were performed FFR measurement, should be received intensive LDL-C management. In a previous study by Nakamura et al 15 , uncontrolled LDL-C levels were found to be associated with a higher risk of deferred lesion failure and any unplanned revascularization in patients with deferred lesion. Despite the well-established importance of LDL-C management in patients with CAD, our study findings suggest that there may be insufficient LDL-C management in clinical practice after FFR measurement.…”

Long‐term outcome after deferred revascularization due to negative fractional flow reserve in intermediate coronary lesions

“… 18,20,21,24 Other factors identified in those studies, which would be associated with DTLF or higher rates of more general cardiovascular events, however, cannot be confirmed here. A reason for this could be that factors such as LDL‐C values after baseline FFR have a stronger predictive value than statin use alone, and, thus, could be of additive value to risk factors identified in this study 34 …”

“…Likewise, Hakeem et al reported a DTLF event rate of 18 and 9.5%, respectively, in patients initially presenting with ACS or stable CAD after 3.4 years follow‐up 18 . In stable CAD patients, Nakamura et al reported a DTLF rate of 7.8% at 2.8 years follow‐up 34 . In ACS patients, Picchi et al reported a DTLF event rate of 9% at 2 years follow‐up.…”

Trends in LDL-C following coronary angiography involving assessment by fractional flow reserve in obstructive vs non-obstructive coronary artery disease

“…Statin use at discharge was higher among those with LDL-C < 70 mg/dL (93.4% vs 81.7%, p = 0.032), and a similar trend toward higher statin use was seen at the time of last follow-up among those with LDL-C < 70 mg/dL (91.8% vs 80.9%, p = 0.053). Interestingly, there was a greater rate of deferred lesion failure (defined as either deferred lesion revascularization or deferred vessel MI) among those with LDL-C > 70 mg/dL [22] . In contrast to these findings we observed a loss of initial intensification of therapy over time among those with FFR > 0.8.…”