ABSTRACT
BACKGROUND: Current guidelines recommend a stepwise initiation of lipid-lowering therapy after percutaneous coronary interventions (PCI) in treatment-naïve individuals. Patients might benefit from an earlier and stronger low-density lipoprotein-cholesterol (LDL-C) reduction through upfront combination therapies. METHODS: This retrospective study included patients without previous lipid-lowering therapy undergoing acute or elective PCI with stent implantation between January 2016 and December 2019. Patients initiated on statin monotherapy vs. a combination of statin and ezetimibe were compared. The primary endpoint was an LDLC reduction into the target range of <â¯55â¯mg/dL at 3 months. The secondary endpoint was the occurrence of major cardiovascular events (MACE). RESULTS: A total of 204 lipid-lowering therapy naive patients were included, of whom 157 (77.0%) received statin monotherapy and 47 (23.0%) combination therapy. Median LDLC levels were higher in patients initiated on combination therapy vs. monotherapy (140â¯mg/dL, interquartile range, IQR, 123-167â¯mg/dL vs. 102â¯mg/dL, IQR 80-136â¯mg/dL, pâ¯< 0.001). The LDLC reduction was greater in patients treated with combination therapy vs. statin monotherapy (-73â¯mg/dL, -52.1% vs. -43â¯mg/dL, -42.2%, pâ¯< 0.001). While the primary endpoint was similar between groups (44.7% vs. 36.1%, pâ¯= 0.275), combination therapy significantly increased the proportion of patients achieving the treatment target in the presence of an admission LDL-Câ¯> 120â¯mg/dL (46.2% vs. 26.2%, pâ¯= 0.031). The rates of MACE were similar between the two groups (10.6% vs. 17.8%, pâ¯= 0.237) at a median follow-up of 2.2 years, IQR 1.46-3.10 years. CONCLUSION: Immediate initiation of high-intensity statin and ezetimibe treatment might be considered as the default strategy in treatment-naïve patients with high admission LDLC undergoing PCI.
