Comparative prognostic value of low-density lipoprotein cholesterol and C-reactive protein in patients with stable coronary artery disease treated with percutaneous coronary intervention and chronic statin therapy

BackgroundThe comparative prognostic value of low density lipoprotein-cholesterol (LDL-C) and C-reactive protein (CRP) in patients with stable coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) and statin therapy is poorly investigated.MethodsThe study included 7595 patients with stable CAD treated with PCI. Based on a cut-off of 100 mg/dl for LDL-C and 3 mg/L for CRP, patients were divided into 4 groups: patients with LDL-C ≤ 100 mg/dl and CRP ≤ 3 mg/L (n = 2795); patients with LDL-C > 100 mg/dl and CRP ≤ 3 mg/L (n = 2091); patients with LDL-C ≤ 100 mg/dl and CRP > 3 mg/L (n = 1296); and patients with LDL-C > 100 mg/dl and CRP > 3 mg/L (n = 1413). Statins at discharge were prescribed in all patients. The primary outcome was 1-year all-cause mortality.ResultsOne-year mortality was 2.1% (160 deaths): 1.2% (33 deaths) among patients with LDL-C ≤ 100 mg/dl and CRP ≤ 3 mg/L, 1.4% (28 deaths) among patients with LDL-C > 100 mg/dl and CRP ≤ 3 mg/L, 4.8% (60 deaths) among patients with LDL-C ≤ 100 mg/dl and CRP > 3 mg/L and 2.9% (39 deaths) among patients with LDL-C > 100 mg/dl and CRP > 3 mg/L (P < 0.001). After adjustment, CRP (hazard ratio [HR] = 1.64, 95% confidence interval [CI] 1.33–2.02, for 1 standard deviation increase in the logarithmic scale) but not LDL-C (HR = 1.03 [0.90–1.17], for 30 mg/dl increase) showed an independent association with 1-year mortality. CRP (P = 0.045) but not LDL-C (P = 0.294) increased the discriminatory power of multivariable model for prediction of mortality.ConclusionIn patients with stable CAD treated with PCI and statin therapy, CRP but not LDL-C was independently associated with increased risk of 1-year mortality.