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Effect of low-density lipoprotein cholesterol on the geometry of coronary bifurcation lesions and clinical outcomes of coronary interventions in the J-REVERSE registry

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Abstract

We investigated the effect of low-density lipoprotein cholesterol (LDL-C) on the geometry of coronary bifurcation lesions. A total of 300 non-left main bifurcation lesions in 298 patients from J-REVERSE registry were classified according to statin treatment status at admission (NT, non-treated; ST, statin-treated) and were further subdivided based on LDL-C levels with a cutoff of 100 mg/dL (NT–high, n = 76 lesions; NT–low, n = 46; ST–high, n = 99 and ST–low, n = 79). In addition, a group with strict control of LDL-C (< 70 mg/dL) was defined (ST–SC; n = 19). The NT–high group had higher angled bifurcations compared to that in the NT–low group (59.1° ± 21.5° vs. 50.3° ± 18.6°, p = 0.02). In the multivariate analysis, NT–high group was an independent factor contributing on generation of higher angled (> 80°) lesion (odds ratio 3.77, 95% CI 1.05–13.5, p = 0.04). The NT–low group had more men (95.6 vs. 81.6%, p = 0.03), and greater plaque volume in the distal main vessel (7.1 ± 3.2 mm3/mm vs. 5.7 ± 2.7 mm3/mm, p = 0.02), compared to those in the NT–high group. LDL-C was more likely to remain high after statin treatment in younger patients (65.3 ± 3.6 years vs. 68.6 ± 8.4 years, p = 0.02) and current smokers (36.7 vs. 16.9%, p = 0.004). The ST–SC group had limited luminal volume expansion compared to that in the ST–high group (proximal: 6.7 ± 1.4 mm3/mm vs. 7.7 ± 2.3 mm3/mm, p = 0.04; distal: 5.3 ± 1.5 mm3/mm vs. 6.5 ± 1.9 mm3/mm, p = 0.04), regardless of similar plaque volumes. Elevated LDL-C is likely to promote the generation of higher angled bifurcation lesions and multiple risk factors lead to a more progressed bifurcation lesion even in patients with lower LDL-C levels.

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Acknowledgements

J-REVERSE was supported by unrestricted research Grants from Abbott Vascular, Cordis Corporation, Orbus Neich, and Kaneka Corporation.

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Author notes

  1. Kenichi Fujii

    Present address: Department of Cardiology, Higashi Takarazuka Sato Hospital, Takarazuka, Japan

  2. Shin-ichiro Yamada

    Present address: Department of Cardiology, Kita Harima Medical Center, Ono, Japan

Authors and Affiliations

  1. Department of Cardiology, Cardiovascular Center, Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan

    Yoshinobu Murasato

  2. Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan

    Yoshinobu Murasato

  3. Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan

    Yoshihisa Kinoshita

  4. Department of Cardiology, Saiseikai Yokohama-Eastern Hospital, Yokohama, Japan

    Masahiro Yamawaki

  5. Department of Cardiovascular Medicine, Kobe University, Kobe, Japan

    Toshiro Shinke

  6. Department of Cardiology, Rinku General Medical Center, Izumi-Sano, Japan

    Yoshihiro Takeda

  7. Department of Cardiovascular Medicine, Hyogo Medical University, Nishinomiya, Japan

    Kenichi Fujii

  8. Department of Cardiovascular Medicine, Himeji Cardiovascular Center, Himeji, Japan

    Shin-ichiro Yamada

  9. Department of Cardiovascular Medicine, Cardiovascular Center, Shiroyama Hospital, Habikino, Japan

    Yoshihisa Shimada

  10. Department of Cardiovascular Medicine, Cardiovascular Center Hokkaido Ono Hospital, Sapporo, Japan

    Takehiro Yamashita

  11. Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan

    Kazuhiko Yumoto

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  1. Yoshinobu Murasato
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Correspondence to Yoshinobu Murasato.

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Murasato, Y., Kinoshita, Y., Yamawaki, M. et al. Effect of low-density lipoprotein cholesterol on the geometry of coronary bifurcation lesions and clinical outcomes of coronary interventions in the J-REVERSE registry. Cardiovasc Interv and Ther 33, 360–371 (2018). https://doi.org/10.1007/s12928-017-0498-1

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