Abstract 15463: Impact of Low-Density Lipoprotein Cholesterol in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

Introduction:Elevated low-density lipoprotein cholesterol (LDL-C) levels are strongly associated with coronary risk in the general population. Chronic kidney disease (CKD) is a common co-morbidity in patients undergoing percutaneous coronary intervention (PCI), but the impact of high LDL-C in these subjects remains unclear. The present study aims to investigate the relation between LDL-C and adverse events after PCI according to the presence of CKD.Hypothesis:The prognostic relevance of LDL-C on cardiovascular outcomes is influenced by the presence of concomitant CKD.Methods:Data from all PCI procedures between 2009 and 2017 in a single tertiary center was prospectively collected. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73m2. Exclusion criteria were end-stage renal failure (requiring dialysis or estimated glomerular filtration rate <15 mL/min/1.73m2) and conditions associated with pathologically lowered LDL-C (body mass index <18.5 kg/m2, ejection fraction <30%, and neoplastic disease). Baseline LDL-C levels were classified as either high (?90 mg/dl) or low (<90 mg/dl). The primary endpoint of interest was myocardial infarction (MI) at 1 year.Results:A total of 12,823 subjects were included, of which 3,253 (25.4%) had CKD. High baseline LDL-C was present in 22.7% and 27.6% of CKD and non-CKD patients, respectively. Overall, patients with high LDL-C levels experienced higher rates of MI at 1 year (Figure). However, while the risk of MI was significantly increased in non-CKD patients with high LDL-C as compared to low LDL-C (adjusted HR: 1.78 [95% CI, 1.22-2.60]; p=0.003), no such trend was observed among CKD patients (adjusted HR: 1.40 [0.78-2.49]; p=0.26).Conclusions:The impact of LDL-C levels on the risk of MI differs between CKD and non-CKD patients. Prognostic implications of high LDL-C may be attenuated in CKD patients undergoing PCI.