Impact of a personalized, strike early and strong lipid-lowering approach on LDL-cholesterol levels and cardiovascular outcome in patients with acute myocardial infarction.

Abstract

Aims: Considering the lack of evidence, we evaluated the impact on cardiovascular outcome of the systematic introduction in our institution of a personalized strike early and strong (SES) approach for lipid-lowering therapy (LLT) in patients admitted for acute myocardial infarction (MI).

Methods and results: We retrospectively analyzed data from 500 consecutive patients hospitalized across three periods: Period A (N=198, January-June 2019), when the LDL-C goal was <70 mg/dL and a stepwise LLT approach was recommended; Period B (N=180, January-June 2021), when the LDL-C goal was <55 mg/dL and a stepwise approach was recommended; Period C (N=122, January-June 2023), when the LDL-C goal was <55 mg/dL and our SES protocol was implemented. Primary endpoints were achievement of the LDL-C goal during follow-up and one-year incidence of major adverse cardiovascular events (MACE). Compared to the other periods, in Period C there was a higher use of potent statins, alone or in combination with ezetimibe, and of PCSK9 inhibitors at discharge. This translated into higher achievement of the LDL-C goal (83% vs 55% in Period A and 43% in Period B; p<0.001) and reduced incidence of MACE (3% vs 12% and 11%; p=0.026). MACE rates were lowest in patients with early and sustained LDL-C <55 mg/dL and in those achieving both LDL-C <55 mg/dL and ≥50% LDL-C reduction.

Conclusion: The systematic introduction of a personalized, SES strategy for LLT in patients with acute MI led to greater achievement of LDL-C goal and lower risk of MACE at one year vs the stepwise approach.