Physicians' Academy for Cardiovascular Education

Non-linear association between LDL-c levels and risk of in-hospital bleeding after PCI

LDL cholesterol levels and in-hospital bleeding in patients on high-intensity antithrombotic therapy: findings from the CCC-ACS project

Literature - Yang Q, Sun D, Pei C et al. - Eur Heart J. 2021 Aug 31;42(33):3175-3186. doi: 10.1093/eurheartj/ehab418.

Introduction and methods

Bleeding events are the most common non-cardiac complication after PCI [1]. Some studies provided evidence for a potential link between cholesterol metabolism and platelet responsiveness [2,3]. This study investigated the relationships between LDL-c levels, major bleeds and net clinical outcome in a nationwide ACS registry.

The CCC-ACS project is an ongoing nationwide quality improvement project enrolling patients with ACS in China [4]. The current study included a total of 42378 ACS patients treated with PCI. In-hospital outcomes included a composite of major bleeds (BARC type 3b-3c and type 5, TIMI major bleeding or PLATO life-threatening major bleeding), ischemic events, in-hospital mortality, and net clinical outcome (any occurrence of major bleed, ischemic event or mortality). During a median hospital stay of 8 days (IQR 6-11 days), a total of 615 major bleeds, 218 ischemic strokes and 337 deaths were recorded.

Main results


This study in a nationwide ACS registry found a non-linear relationship between LDL-c levels and major in-hospital bleeds, with a higher risk at lower LDL-c levels in ACS patients after PCI. A threshold value of LDL-c<70 mg/dL was associated with an increased major bleeding risk and net clinical outcome in this population.


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Find this article online at Eur Heart J.

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