Effect of low-density lipoprotein cholesterol on the geometry of coronary bifurcation lesions and clinical outcomes of coronary interventions in the J-REVERSE registry

• Published in: Cardiovascular intervention and therapeutics 2018-10, Vol.33 (4), p.360-371
• Main Authors: Murasato, Yoshinobu, Kinoshita, Yoshihisa, Yamawaki, Masahiro, Shinke, Toshiro, Takeda, Yoshihiro, Fujii, Kenichi, Yamada, Shin-ichiro, Shimada, Yoshihisa, Yamashita, Takehiro, Yumoto, Kazuhiko
• Format: Article
• Language: English
• Subjects: Aged; Cardiology; Cholesterol, LDL - blood; Coronary Artery Disease - blood; Coronary Artery Disease - pathology; Coronary Artery Disease - surgery; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Percutaneous Coronary Intervention - methods; Plaque, Atherosclerotic - blood; Plaque, Atherosclerotic - pathology; Plaque, Atherosclerotic - surgery; Prospective Studies; Registries; Risk Assessment - methods; Risk Factors; Ultrasonography, Interventional - methods
• ISSN: 1868-4300; 1868-4297
• DOI: 10.1007/s12928-017-0498-1

We investigated the effect of low-density lipoprotein cholesterol (LDL-C) on the geometry of coronary bifurcation lesions. A total of 300 non-left main bifurcation lesions in 298 patients from J-REVERSE registry were classified according to statin treatment status at admission (NT, non-treated; ST, statin-treated) and were further subdivided based on LDL-C levels with a cutoff of 100 mg/dL (NT–high, n  = 76 lesions; NT–low, n  = 46; ST–high, n  = 99 and ST–low, n  = 79). In addition, a group with strict control of LDL-C ( 80°) lesion (odds ratio 3.77, 95% CI 1.05–13.5, p  = 0.04). The NT–low group had more men (95.6 vs. 81.6%, p  = 0.03), and greater plaque volume in the distal main vessel (7.1 ± 3.2 mm 3 /mm vs. 5.7 ± 2.7 mm 3 /mm, p  = 0.02), compared to those in the NT–high group. LDL-C was more likely to remain high after statin treatment in younger patients (65.3 ± 3.6 years vs. 68.6 ± 8.4 years, p  = 0.02) and current smokers (36.7 vs. 16.9%, p  = 0.004). The ST–SC group had limited luminal volume expansion compared to that in the ST–high group (proximal: 6.7 ± 1.4 mm 3 /mm vs. 7.7 ± 2.3 mm 3 /mm, p  = 0.04; distal: 5.3 ± 1.5 mm 3 /mm vs. 6.5 ± 1.9 mm 3 /mm, p  = 0.04), regardless of similar plaque volumes. Elevated LDL-C is likely to promote the generation of higher angled bifurcation lesions and multiple risk factors lead to a more progressed bifurcation lesion even in patients with lower LDL-C levels.