Clinical significance of low-density lipoprotein cholesterol percentage reduction and attained levels after percutaneous coronary intervention
Bibliographic record
Abstract
BACKGROUND: Differences exist between European and American guideline recommendations regarding targets for low-density lipoprotein cholesterol (LDL-C) levels after percutaneous coronary intervention (PCI), with European guidance advocating for more aggressive reduction to less than 1.4 mmol/L compared with the American guideline, which recommends an LDL-C level of 1.8 mmol/L or greater as the threshold for treatment intensification. We aimed to evaluate clinical outcomes according to percentage reduction of LDL-C levels and to compare the outcomes according to the attained LDL-C levels after PCI. METHODS: This nationwide cohort study included adults in South Korea who underwent PCI and health screening within 3 years before and after PCI. Participants were divided into groups with a reduction of LDL-C levels of less than 50% and of 50% or greater. The group with LDL-C reduction of 50% or greater was stratified into categories of LDL-C level after PCI: less than 1.4 mmol/L, 1.4 to less than 1.8 mmol/L, and 1.8 mmol/L or greater. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, spontaneous myocardial infarction (MI), repeat revascularization, and ischemic stroke. RESULTS: = 54 551). During a median follow-up of 7.4 years, the group with a reduction of 50% or greater had a multivariable-adjusted hazard ratio (HR) for MACCE of 0.78 (95% confidence interval [CI] 0.76-0.80). Among patients who achieved a reduction of LDL-C levels of 50% or greater, the multivariable-adjusted HR for MACCE was 1.07 (95% CI 1.02-1.13) for the group with LDL-C levels of 1.4 to less than 1.8 mmol/L after PCI and 1.12 (95% CI 1.04-1.21) for the group with levels of greater than 1.8 mmol/L. The risk of spontaneous MI was also higher in the group with LDL-C levels of 1.8 mmol/L or greater than in the group with levels of less than 1.4 mmol/L (HR 1.36, 95% CI 1.14-1.62). INTERPRETATION: Among patients who underwent PCI, those who achieved a reduction in LDL-C levels of 50% or greater had a reduced risk of MACCE, regardless of baseline LDL-C levels. Among patients with a reduction in LDL-C levels of 50% or greater, compared with patients with an LDL-C level less than 1.4 mmol/L after PCI, those with an LDL-C level of greater than 1.8 mmol/L and a level of 1.4 to less than 1.8 mmol/L had an increased risk of MACCE. These findings suggest that while achieving an LDL-C reduction of 50% or greater remains a critical therapeutic goal, targeting LDL-C levels of less than 1.4 mmol/L after PCI may provide additional clinical benefit. TRIAL REGISTRATION: ClinicalTrials.gov, NCT06338956.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".