A Follow-up Analysis Of The Lipid Levels In Patients With Coronary Artery Disease After Percutaneous Coronary Intervention

Background and Objective: Over decades, a lot of domestic and internationalstudies have approved that low density lipoprotein cholesterol (LDL) plays a criticalrole in the development and progress of coronary artery disease (CAD), as well as theprognosis of CAD patients after percutaneous coronary intervention (PCI). In recentyears, several guidelines have stratified the lipid risk of different cardiovascular diseaseconditions, aiming at a target value for lipid control. However, nowadays few domesticdata on the profile of lipid control and the attainment rate of target levels in patientswith CAD, especially those after PCI, can be acquired in China. Therefore, this study isdesigned to analyze the cholesterol levels in CAD patients before PCI and the targetlevel attainment rate of lipid control after PCI.Methods: From March2011to March2012, a total of1025patients diagnosed ofCAD (including acute myocardial infarction and unstable angina), successfully receivedstent implantation in primary or elective PCI in the Cardiology Department of the FirstAffiliated Hospital of Dalian Medical University, since coronary arteriography showed75%or more stenosis of the coronary artery (ies). The medical documents of thosepatients stored in the PCI follow-up database were reviewed in the current study.193cases were excluded due to lack of blood cholesterol level at admission and failure ofregular follow up. Therefore832cases, including657males (79%), and175females(21%), aged between30and89(range:61±10.4years), were enrolled. Bloodcholesterol level, total cholesterol (TC), triglyceride (TG), LDL, high densitylipoprotein (HDL), creatinine kinase (CK), alanine aminotransferase (ALT), aspartateaminotransferase (AST) were detected in all subjects within24hours after admission. According to different LDL levels, the participants were randomly divided into fourgroups: group A (<80mg/dl), group B (80-99mg/dl), group C (100-119mg/dl) and groupD (≥120mg/dl). Meanwhile, the relationships between lipid levels and the differences inthe following aspects were also analyzed: sex, age (<60years as middle age and youngage group,≥60years as old age group), with or without a history of CAD, smoking,accompanying diseases (diabetes mellitus, hypertension, hypercholesterolemia), pasthistory of myocardial infarction, past history of PCI treatment. We also assessedpatients’ lipid lowering therapy and detected their cholesterol levels1month and9months after PCI. We referred to the2011ESC/EAS lipid management guideline,2007China adult blood lipid abnormalities prevention guideline and2012China PCIguideline to calculate the attainment rates of LDL target level.Results:(1)There was no significant difference in age, CAD family history,smoking history, hypertension history and past history of MI statistically among thefour groups (P>0.05). However, the differences in sex, diabetes mellitus history,hypercholesterolemia, past history of PCI, pathology of diseases, TC, TG and HDLwere significant (P<0.05).(2) According to2011ESC/EAS lipid management guideline, the compliancerates of LDL levels1month and9months after PCI were25.2%(210patients) and22.2%(186patients) in total, respectively;44.5%(69patients) and34.2%(53patients)in group A;25.8%(62patients) and24.6%(59patients) in group B;20.2%(49patients)and17.7%(43patients) in group C;15.5%(30patients) and15.15%(30patients) ingroup D, respectively. The difference among each group was statistically significant(P<0.001). In accordance with2007China adult blood cholesterol prevention guidelineand2012China PCI guideline, the total LDL target level attainment rates1month and9months post procedure were46.5%(387participants) and42.3%(352participants)respectively. Among the four subgroups，the LDL target level attainment rates1monthand9months post procedure were as follows: group A:70.3%(109patients),61.9%(96patients); group B:49.2%(118patients),48.8%(117patients); group C:42.4%(103patients),37.9%(92patients); group D:24.2%(47patients),29.4%(57patients).The difference in each group was statistically different (P<0.001).(3) In accordance with the Chinese guideline (LDL <80mg/dl), the Logisticregression analysis of LDL levels1month and9months post PCI procedure showedthat age (≥60yrs/<60yrs, OR=0.599,95%CI:0.440-0.817), past MI history (OR=0.650,95%CI:0.470-0.899), and baseline LDL levels (OR=0.601,95%CI:0.507-0.711) were independent risk factors1month post procedure. Moreover, the followings are theindependent risk factors for target LDL levels9months after PCI: sex (M/F, OR=1.532,95%CI=1.006-2.331), past MI history (OR=0.721,95%CI:0.522-0.995), pastPCI (OR=0.580,95%CI:0.340–0.990) and baseline LDL level (OR=0.622,95%CI:0.526–0.735).Conclusion:(1) The baseline LDL level is higher in CAD patients with thefollowing characteristics: female, diabetes mellitus, hypercholesterolemia and AMI orhigher levels of TC, TG, HDL on admission. While, it is lower in CAD patients withpast PCI therapy.(2) Currently, the lipid control profile in patients with CAD after PCI is hardlycomparable to the target levels listed in guidelines, especially in female patients, aged≥60years old, with past history of MI, PCI history and higher baseline LDL level.Hence, the physicians should actively regulate the cholesterol lowering therapy inpractice and strengthen lipid management with regard to those with the above riskfactors.