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

Background: 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. Methods: 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. Results: 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 Conclusions: 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.