Lowering the repeat unplanned revascularization rate after coronary stenting by focusing on the long-term stable control of low-density lipoprotein cholesterol

Patients with coronary artery disease (CAD), after first percutaneous coronary intervention (PCI), often need repeat unplanned percutaneous revascularization due to plaque progression in culprit or non-culprit lesions, including target lesion revascularization (TLR), target vessel revascularization (TVR), and other vessel revascularization (OVR).[1] Low-density lipoprotein cholesterol (LDL-C) levels are controllable and its reduction is integral to reducing major adverse cardiac events after PCI. In this study, active lipid-lowering therapy was widely appreciated early after coronary stenting, showing an initial decline in levels of LDL-C, while its emphasis and recognition was attenuated over time with an increased risk of revascularization due to higher levels of LDL-C.

Current Use of Oral Anticoagulants and Prognostic Analysis in Patients with Atrial Fibrillation Undergoing Coronary Stenting

Background： It is currently believed that triple oral antithrombotic therapy in patients with atrial fibrillation （AF） after percutaneous coronary intervention （PCI） should be recommended if there are no contraindications. However, selecting triple therapy for AF patients undergoing PCI is still challenging when bleeding risk is considered. This study aimed to investigate the current use of oral anticoagulants （Vitamin K antagonists [VKA]） and perform prognostic analysis in real-world patients with AF undergoing coronary stenting. Methods： A total of 276 consecutive coronary artery disease （CAD） patients with or without AF undergoing coronary stenting were retrospectively evaluated and analyzed. The univariate and multivariate analyses were conducted to explore the current use of VKA and prognosis of patients with AF undergoing coronary stenting. The primary end-point was composite of all-cause death, nonfatal recurrent myocardial infarction, stroke, serious bleeding events, unplanned repeat revascularization, and worsening heart failure at 12-month follow-up after coronary stenting. Results： AF patients undergoing coronary stenting have more clinical concomitant diseases. Only 9.0% AF patients after coronary stenting received triple antithrombotic therapy （VKA, aspirin, and clopidogrel） at discharge. AF was independently associated with increased risk of the 12-month composite end-points （relative risk = 5.732, 95% confidence interval 1.786-18.396, P = 0.003）. Conclusions： In real-life AF patients undergoing coronary stenting, guideline-recommended VKA was less used. AF patients had adjusted worse prognosis during 12-month follow-up after discharge. It is of utmost importance to improve the current status of oral anticoagulants use.