Impact of cumulative exposure to low-density lipoprotein cholesterol on cardiovascular outcomes post-percutaneous coronary intervention

LAN Wen-da; SUN Ya-zhao; LI Xiang-hua; MENG Qing-lan

doi:10.3969/j.issn.1672-5301.2025.02.012

Abstract：Objective To evaluate the impact of cumulative exposure to low-density lipoprotein cholesterol(LDL-C)on cardiovascular outcomes after percutaneous coronary intervention(PCI).Methods 260 patients with coronary artery disease who underwent percutaneous coronary intervention(PCI)at Cangzhou People's Hospital from January 2018 to June 2018 were included.The cumulative exposure value of LDL-C(cumLDL-C)was calculated based on clinical data collected during the initial hospitalization and the results of lipid profile assessments conducted in 2019 and 2020.The major cardiovascular events occurring during the follow-up period were also recorded.Results During the follow-up period,a total of 48 patients experienced heart failure,non-fatal myocardial infarction,in-stent restenosis,progression of existing lesions or new coronary artery lesions.Compared to the group with good prognosis,the poor prognosis group had higher proportions of smoking and diabetes,as well as elevated levels of total coronary plaque burden,non-calcified plaque burden,calcified plaque burden,uric acid,total cholesterol(TC),LDL-C and cumLDL-C(all P＜0.05),while the proportion of ACEI/ARB medication use was lower(P＜0.05).Using the lowest quartile of cumLDL-C as the reference group and adjusting for confounding factors,the multivariate Logistic regression analysis showed that patients with cumLDL-C levels of 5.01-5.72 mmol/L and＞5.72 mmol/L had a 4.28-fold(95％CI 1.045-17.496,P=0.043)and 4.94-fold(95％CI 1.209-20.149,P=0.026)increased risk of major cardiovascular events,respectively.The receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)for cumLDL-C in predicting major cardiovascular events post-PCI was 0.812,with a sensitivity and specificity of 79.17％and 82.08％,respectively.Additionally,the predictive value of cumLDL-C was significantly higher than that of baseline LDL-C(Z=2.207,P=0.027).Spearman correlation analysis showed that cumLDL-C was significantly positively correlated with both the total coronary plaque burden(r=0.249,P＜0.001)and the non-calcified plaque burden(r=0.189,P=0.001).Conclusions Higher cumLDL-C levels are significantly related with an increased risk of cardiovascular events post-PCI.This finding suggests that in the management of patients post-PCI,special attention should be given to monitoring and controlling the long-term cumulative exposure to LDL-C to reduce the risk of adverse cardiovascular events.