Impact of the attainment of current recommended low-density lipoprotein cholesterol goal of less than 70 mg/dl on clinical outcomes in very high-risk patients treated with drug-eluting stents

OBJECTIVEWe sought to evaluate whether the attainment of low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dl would affect clinical outcomes in Korean patients treated with drug-eluting stents (DES). BACKGROUNDThe current cholesterol guideline has strongly recommended reducing LDL-C to less than 70 mg/dl as the goal of therapy for very high-risk patients. METHODSFrom 2003 to 2006, a total of 1347 very high-risk patients were treated with DES. Among them, we identified 578 eligible patients with follow-up LDL-C within 6–8 months after DES and divided these patients into two groups based on the level of follow-up LDL-Cgroup A, follow-up LDL less than 70 mg/dl (n=234) and group B, LDL of at least 70 mg/dl (n=344). Then we analyzed the incidence of major adverse cardiac and cerebrovascular events [MACCEdeath, myocardial infarction, target-vessel revascularization (TVR), non-TVR, cerebrovascular accidents] of both the groups. RESULTSDuring the follow-up (mean duration=30±10 months), group A showed a significantly lower TVR (6%) and MACCE rate (14%), compared with group B (TVR12%, P=0.032; MACCE24%, P=0.002). However, there was no difference in the rate of death, myocardial infarction, or cerebrovascular accidents between the two groups. By multivariate analysis, follow-up LDL-C level of less than 70 mg/dl was one of the significant predictors for the occurrence of MACCE (odds ratio=0.39, 95% confidence interval0.21–0.72, P=0.003) or TVR (odds ratio=0.39, 95% confidence interval0.20–0.76, P=0.005). CONCLUSIONThis study showed that the attainment of LDL-C goal of less than 70 mg/dl was significantly associated with a lower MACCE or TVR rate in very high-risk Korean patients treated with DES.