Prognostic impact of familial hypercholesterolemia on long-term outcomes in patients undergoing percutaneous coronary intervention

•Familial hypercholesterolemia (FH) is a major risk factor for premature and subsequent cardiovascular disease. •Data on long-term major adverse cardiovascular events in patients with FH after coronary stenting are scarce. •5.0% were classified with probable/definite FH. •Mean follow-up was 6.0 ± 2.4 years. •Probable/definite FH was associated with a 1.9-fold increased risk for MACE. Background Patients with familial hypercholesterolemia (FH) are at increased risk for premature and subsequent cardiovascular disease. Data on long-term major adverse cardiovascular events (MACE) in patients with FH after percutaneous coronary intervention (PCI) in the era of high-intensity statins are scarce. Objective We assessed the prognostic impact of clinically diagnosed FH on long-term MACE, a composite of all-cause death, myocardial infarction, and ischemic stroke in patients admitted for stable coronary artery disease (SCAD) or acute coronary syndromes (ACSs) undergoing PCI. Methods FH was diagnosed according to the Dutch Lipid Clinic Network diagnosis criteria: “Unlikely FH” diagnosis was defined as 0 to 2 points, “possible FH” as 3 to 5 points, and “probable/definite FH” diagnosis as 6 or higher. Results From a total of 1550 eligible patients (47.4% were admitted for SCAD and 52.6% for ACS), 77 (5.0%) were classified as probable/definite FH, 332 (21.4%) as possible FH, and 1141 (73.6%) as unlikely FH. Mean follow-up was 6.0 ± 2.4 years. After adjustment for possible confounders, patients classified with probable or definite FH (hazard ratio [HR] 1.922 [95% confidence interval (CI) 1.220–2.999]; P = .004), but not patients with possible FH (HR 1.105 [95% CI 0.843–1.447]; P = .470) faced a significant, approximately 2-fold increased risk of MACE compared with patients with unlikely FH. Conclusion After adjustment for confounders, patients with probable or definite FH faced an approximate 2-fold increased risk for long-term MACE compared with patients without FH despite the widespread use of high-intensity statins. The new option of proprotein convertase subtilisin/kexin type 9 gene inhibitors in addition to other current optimal lipid-lowering strategies might help to further improve clinical outcome in patients with probable/definite FH. Patients with familial hypercholesterolemia (FH) are at increased risk for premature and subsequent cardiovascular disease. Data on long-term major adverse cardiovascular events (MACE) in patients with FH after percutaneous coronary intervention (PCI) in the era of high-intensity statins are scarce. We assessed the prognostic impact of clinically diagnosed FH on long-term MACE, a composite of all-cause death, myocardial infarction, and ischemic stroke in patients admitted for stable coronary artery disease (SCAD) or acute coronary syndromes (ACSs) undergoing PCI. FH was diagnosed according to the Dutch Lipid Clinic Network diagnosis criteria: “Unlikely FH” diagnosis was defined as 0 to 2 points, “possible FH” as 3 to 5 points, and “probable/definite FH” diagnosis as 6 or higher. From a total of 1550 eligible patients (47.4% were admitted for SCAD and 52.6% for ACS), 77 (5.0%) were classified as probable/definite FH, 332 (21.4%) as possible FH, and 1141 (73.6%) as unlikely FH. Mean follow-up was 6.0 ± 2.4 years. After adjustment for possible confounders, patients classified with probable or definite FH (hazard ratio [HR] 1.922 [95% confidence interval (CI) 1.220–2.999]; P = .004), but not patients with possible FH (HR 1.105 [95% CI 0.843–1.447]; P = .470) faced a significant, approximately 2-fold increased risk of MACE compared with patients with unlikely FH. After adjustment for confounders, patients with probable or definite FH faced an approximate 2-fold increased risk for long-term MACE compared with patients without FH despite the widespread use of high-intensity statins. The new option of proprotein convertase subtilisin/kexin type 9 gene inhibitors in addition to other current optimal lipid-lowering strategies might help to further improve clinical outcome in patients with probable/definite FH.