Chronic kidney disease is associated with worse survival after revascularization in subjects with genetically diagnosed familial hypercholesterolemia and significant coronary artery disease

Familial hypercholesterolemia (FH) is a genetic disorder associated with elevated low-density lipoprotein cholesterol (LDL-C) and coronary artery disease (CAD). Few studies have reported survival data and the associated factors in FH patients with significant CAD after revascularization. We retrospectively analyzed 79 genetically confirmed FH who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a single medical center. Genetic variants for FH were identified by next-generation sequencing. A logistic regression was performed to find the associated factors for choosing CABG revascularization. The Kaplan-Meier equation and the stratified survival curve with log-rank testing were depicted for significant associated factors for survival. There were 62 men (78.5%) and 17 women (21.5%) in this study. Twenty-three (29.1%) underwent CABG and 56 (70.9%) received only PCI. Logistic regression revealed that a higher LDL-C record and a higher coronary Jeopardy score were associated with CABG revascularization. The median duration of follow-up was 61 months after revascularization and 11 patients (13.9%) died. The cumulative survival at 5 years was 88.5%. The deceased patients had significantly lower estimated glomerular filtration rate (eGFR) (62.3 ± 18.6 vs. 81.2 ± 21.2 ml/min/1.73 m 2 , p = 0.007) and a higher proportion with CKD (54.5% vs. 14.7%, p = 0.007). The Kaplan-Meier equation with log-rank testing ( p = 0.018) showed that subjects with chronic kidney disease (CKD) had worse survival. A higher LDL-C and coronary severity score were associated with CABG revascularization. Chronic kidney disease and lower eGFR were associated with worse survival in subjects with FH and CAD after revascularization.