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. 2023 Feb 13:13:100473.
doi: 10.1016/j.ajpc.2023.100473. eCollection 2023 Mar.

Trends in LDL-C following coronary angiography involving assessment by fractional flow reserve in obstructive vs non-obstructive coronary artery disease

Michael J Wilkinson  1 , Irvin Xu  1 , Rajiv S Vasudevan  1 , Hyeri You  2 , Ronghui Xu  3 , Pam R Taub  1
Affiliations

Trends in LDL-C following coronary angiography involving assessment by fractional flow reserve in obstructive vs non-obstructive coronary artery disease

Michael J Wilkinson et al. Am J Prev Cardiol. .

Abstract

Background: We sought to determine whether management of LDL-C following invasive angiography and assessment by fractional flow reserve (FFR) differs between those with obstructive vs non-obstructive CAD.

Methods: Retrospective study of 721 patients undergoing coronary angiography involving assessment by FFR between 2013 and 2020 at a single academic center. Groups with obstructive vs non-obstructive CAD by index angiographic and FFR findings were compared over 1 year of follow-up.

Results: Based on index angiographic and FFR findings, 421 (58%) patients had obstructive CAD vs 300 (42%) with non-obstructive CAD, mean (±SD) age 66±11 years, 217 (30%) women, and 594 (82%) white. There was no difference in baseline LDL-C. At 3-months follow-up, LDL-C was lower than baseline in both groups, with no between group difference. In contrast, at 6-months, median (Q1, Q3) LDL-C was significantly higher in non-obstructive vs obstructive CAD (LDL-C 73 (60, 93) vs 63 (48, 77) mg/dL, respectively (p = 0.003), (p = 0.001 in multivariable linear regression)). At 12-months, LDL-C remained higher in non-obstructive vs obstructive CAD (LDL-C 73 (49, 86) vs 64 (48, 79) mg/dL, respectively, although not statistically significant (p = 0.104)). The rate of high-intensity statin use was lower among those with non-obstructive CAD vs obstructive CAD at all time points (p < 0.05).

Conclusions: After coronary angiography involving FFR, there is intensification of LDL-C lowering at 3-months follow-up in both obstructive and non-obstructive CAD. However, by 6-months follow-up LDL-C is significantly higher among those with non-obstructive CAD vs obstructive CAD. Following coronary angiography involving FFR, patients with non-obstructive CAD may benefit from greater attention to LDL-C lowering to reduce residual ASCVD risk.

Keywords: Coronary angiography; Coronary artery disease; Dyslipidemia; Fractional flow reserve.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
LDL-C after index fractional flow reserve (FFR) assessment, comparing groups with obstructive vs non-obstructive coronary artery disease. Bars represent median (IQR) LDL-C at baseline, 3, 6, and 12 months. Compared with non-obstructive CAD, LDL-C was significantly lower in those with obstructive CAD at 6 months (*p = 0.003 (Mann-Whitney U test), p = 0.001 (multivariable linear regression)). LDL-C, low density lipoprotein cholesterol.
Central Figure
Central Figure
Following coronary angiography with fractional flow reserve (FFR), those with non-obstructive CAD (vs obstructive CAD) receive less intensive lipid-lowering therapy to lower LDL-C. However, intensification of LDL-C lowering is modest in both groups, and all remain at risk for MACE over 12-months. Therefore, following coronary angiography with FFR, all patients will benefit from greater intensification of lipid-lowering therapy.
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