Intensive Lipid‐Lowering Therapy as per the Latest Dyslipidemia Management Guideline in Predicting Favorable Long‐Term Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study

Abstract

Background There are limited data on low‐density lipoprotein cholesterol (LDL‐C) goal achievement per the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia management guidelines and its impact on long‐term outcomes in patients undergoing coronary artery bypass grafting (CABG). We investigated the association between LDL‐C levels attained 1 year after CABG and the long‐term outcomes. Methods and Results A total of 2072 patients diagnosed with multivessel coronary artery disease and undergoing CABG between 2011 and 2020 were included. Patients were categorized by lipid levels at 1 year after CABG, and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs) was evaluated. The goal of LDL‐C <1.40 mmol/L was attained in only 310 patients (14.9%). During a mean follow‐up of 4.2 years after the index 1‐year assessment, 25.0% of the patients experienced MACCEs. Multivariable‐adjusted hazard ratios (95% CIs) for MACCEs, cardiac death, nonfatal myocardial infarction, nonfatal stroke, revascularization, and cardiac rehospitalization were 1.94 (1.41–2.67), 2.27 (1.29–3.99), 2.45 (1.55–3.88), 1.17 (0.63–2.21), 2.47 (1.31–4.66), and 1.87 (1.19–2.95), respectively, in patients with LDL‐C ≥2.60 mmol/L, compared with patients with LDL‐C <1.40 mmol/L. The LDL‐C levels at 1‐year post‐CABG were independently associated with long‐term MACCEs. Conclusions This retrospective analysis demonstrates that lipid goals are not attained in the vast majority of patients at 1 year after CABG, which is independently associated with the increased risk of long‐term MACCEs. Further prospective, multicenter studies are warranted to validate if intensive lipid management could improve the outcomes of patients undergoing CABG.