PCI Outcomes Registry Delivers Superior LDL to Target Outcomes in Consecutively Enrolled High-Risk Patients Undergoing Procedures in a Large Cardiology Private Practice

Compelling evidence from clinical trials strongly recommends risk-based reduction in LDL-C with a focus on improving management with high-intensity statins and combination therapy in high-risk patients. Large gaps between clinical guidelines and clinical practice exist in Australia despite the abundant opportunities to apply the science. As a large private cardiology network, we undertook an assessment of LDL-C levels using a prospective outcomes registry of patients originally presenting with ACS and undergoing PCI and, who were seen in follow-up between July 2020 and July 2022, to ascertain LDL-C goal attainment in clinical practice relative to published guidelines. This registry enrolled 6,409 individuals (72.7±9.9 years, 75% male) across 80 clinic sites, classified in four cohorts (<1.4 mmol/L, 1.4–1.8 mmol/L, >1.8–2.6 mmol/L and >2.6 mmol/L) as determined by their most recent available LDL-C result. 28% of individuals achieved a LDL of <1.4 mmol/L and a further 35% were at 1.4 to ≤1.8 mmol/L indicating a cumulative 63% of individuals were being treated to LDL-C levels as recommended in the ESC/EAS, NHF and AHA guidelines. State-based differences in achieving an LDL of <1.8 mmol/L were significant (52%–68%) indicating different clinician behaviours potentially impacting patient outcomes. In conclusion, this analysis demonstrates that among high-risk patients in secondary prevention, 63% achieved guideline recommendations. While this is superior to published national and international data and supports the value of the PCI registry, it is far from ideal. State-based differences in clinician behaviours needs further understanding which will be facilitated by ongoing analysis of the PCI registry.