Assessment of the LDL-C/HDL-C ratio as a predictor of one year clinical outcomes in patients with acute coronary syndromes after percutaneous coronary intervention and drug-eluting stent implantation.

ABSTRACT

BACKGROUND: Despite significant advances in the management of acute coronary syndromes (ACS), there are still plenty of patients undergoing percutaneous coronary intervention (PCI) and stent implantation suffered poor prognosis and high treatment expenditure. Evidence increasingly suggests that the ratio of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio might be a novel marker for the risk of atherosclerotic cardiovascular disease, but the impact of LDL-C/HDL-C ratio on 1-year prognosis of drug-eluting stent (DES) implantation patients after PCI is still not reported. Our aim of the study was to investigate the impact of LDL-C/HDL-C ratio on 1-year prognosis of DES implantation patients after PCI. METHODS: Between May 2014 and July 2016, 1937 patients who were underwent primary PCI and DES implantation and achieving LDL-C with statins were enrolled and divided into two groups based on the ratio of LDL-C/HDL-C. RESULTS: The entire occurrence of adverse cardiovascular events according to the ratio of LDL-C/HDL-C showed that there were no significant differences in 1-year cardiovascular death (hazard ratio [HR] 1.97, 95% confidence interval [CI] 0.49 to 7.84, P = 0.329), myocardial infarction (MI) (HR 1.66, 95% CI 0.84 to 3.28, P = 0.172) and bleeding events (HR 1.08, 95% CI 0.83 to 1.41, P = 0.598) The cumulative incidence of target lesion revascularization (TLR) (HR 1.43, 95% CI 1.10 to 1.86, P = 0.007), stent thrombosis (ST) (HR 2.04, 95% CI 1.06 to 3.93, P = 0.037) and major adverse cardiac events (MACE) (HR 1.54, 95% CI 1.24 to 1.91, P <  0.001) were significantly higher in high group than in low group. Multivariate Cox regression analysis revealed that age (HR 1.556, 95%, CI 1.198 to 2.021, P <  0.001), together with diabetes mellitus (HR 1.490, 95% CI 1.142 to 1.945, P = 0.003), and ratio of LDL-C/HDL-C (HR 1.638, 95% CI 1.260 to 2.218, P <  0.001) were independent predictors of 1-year MACE. The Kaplan-Meier cumulative MACE-free survival curves with a log-rank test showed that the presence of high ratio of LDL-C/HDL-C was associated with higher incidences of MACE after PCI with DES implantation. CONCLUSIONS: The high LDL-C/HDL-C ratio was associated with cardiovascular events in patients with ACS after PCI and DES implantation.