Effect of Low-Density Lipoprotein Cholesterol Goal Achievement on Vascular Physiology Evaluated by Quantitative Flow Ratio in Patients Underwent Percutaneous Coronary Intervention

Abstract Purpose The change in coronary physiology from lipid-lowing therapy(LLT)lacks an appropriate examination method. Quantitative flow ratio (QFR) is a novel angiography-based method allowing fast assessment of coronary physiology. This study sought to determine the impact of the low-density lipoprotein cholesterol (LDL-C) goal achievement on coronary physiology through QFR. Methods Patients who underwent percutaneous coronary intervention (PCI) and one-year angiographic follow-up were screened and computed by QFR analysis. According to the LDL-C level at one-year follow-up, patients were divided into two groups:1) goal-achievement group (LDL-C < 1.8 mmol/l or reduction of ≥ 50%, n = 146, lesion = 165); 2) non-achievement group (n = 286, lesion = 331). All QFR data and major adverse cardiovascular and cerebrovascular events (MACCEs) at one year were compared between groups. Results No differences between the groups were found in quantitative coronary angiography (QCA) data and QFR at post-PCI. At one-year follow-up, lower percentage diameter stenosis (DS %) and percentage area stenosis (AS %) were recorded in goal-achievement group (27.89 ± 10.16 vs. 30.93 ± 12.03, p = 0.010, 36.57 ± 16.12 vs. 41.68 ± 17.39, p = 0.003, respectively). Meanwhile, a higher QFR was found in goal-achieved patients (0.96 ± 0.05 vs. 0.94 ± 0.09, p = 0.005). Furthermore, goal-achievement group had a lower incidence of physiological restenosis and MACCEs (2.1% vs. 8.4%, p = 0.018, 5.4 % vs. 12.6 %, p = 0.021, respectively). Conclusions Evaluated by QFR, patients who achieved the LDL-C goal seem to have a better coronary physiological benefit. Meanwhile, this group of patients is presented a better clinical outcome.