Malondialdehyde-modified low-density lipoprotein is a predictor of cardiac events in patients with stable angina on lipid-lowering therapy after percutaneous coronary intervention using drug-eluting stent

Objective: Patients undergoing lipid-lowering therapy after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) are subject to residual risk. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is suggested as a marker of the initiation and acceleration of atherosclerosis. This study aimed to investigate the impact of MDA-LDL on clinical outcomes in patients with stable angina undergoing lipid-lowering therapy after DES implantation. Methods: In this study, 332 patients whose MDA-LDL was measured before PCI with DES were followed clinically (median 2.9 years). Lipid-lowering therapy was conducted, with the target LDL <= 100 mg/dL. We analyzed the composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and any revascularization. Results: MACE was observed in 64 patients (19.3%). MDA-LDL was significantly higher in the MACE group (139.1 +/- 53.2 U/L vs. 106.5 +/- 38.3 U/L, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and hemodialysis (Hazard ratio (HR) 4.60; p < 0.01), MDA-LDL (per 10 U/L, HR 1.14; p < 0.01), multivessel disease (HR 1.78; p = 0.02), and high-density lipoprotein (per 10 mg/dL, HR 0.79; p = 0.03). In the multivariate model, hemodialysis (HR 4.10; p < 0.01) and MDA-LDL (per 10U/L, HR 1.10; p < 0.01) remained significant predictors of MACE. The optimal MDA-LDL threshold for predicting MACE was 114.1 U/L, identified by the receiver operating characteristic curve. Conclusions: MDA-LDL was associated with future cardiac events in patients with stable angina that underwent lipid-lowering therapy after DES-PCI. (C) 2015 Elsevier Ireland Ltd. All rights reserved.