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Poster Networking

Arterial Thromboembolism

PB0046 - Percent Reduction From Baseline Is a Better Target Than Follow-Up Levels in Low-Density Lipoprotein Cholesterol Lowering Therapy For Patients With Acute Myocardial Infarction

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Kyung Hoon Cho, MD, PhD

    Associate Professor
    Chonnam National University Medical School
    Gwangju, Republic of Korea

    • Co-Author(s)

  • JY

    Jung Ho Yang

    Doctor
    Chonnam National University Medical School
    Hwasun-gun, Cholla-namdo, Republic of Korea

  • SL

    Sang Yeub Lee

    Professor
    Chung-Ang University Gwangmyeong Hospital
    Gwangmyeong-si, Kyonggi-do, Republic of Korea

  • MS

    Min-Ho Shin

    Professor
    Chonnam National University Medical School
    Hwasun-gun, Cholla-namdo, Republic of Korea

  • SO

    Seok Oh

    Professor
    Chonnam National University Hospital
    Gwangju, Kwangju-jikhalsi, Republic of Korea

  • MK

    Min Chul Kim

    Professor
    Chonnam National University Medical School
    Gwangju, Kwangju-jikhalsi, Republic of Korea

  • DS

    Doo Sun Sim

    Professor
    Chonnam National University Medical School
    Gwangju, Kwangju-jikhalsi, Republic of Korea

  • YH

    Young Joon Hong

    Professor
    Chonnam National University Medical School
    Gwangju, Kwangju-jikhalsi, Republic of Korea

  • JK

    Ju Han Kim

    Professor
    Chonnam National University Medical School
    Gwangju, Kwangju-jikhalsi, Republic of Korea

  • Youngkeun Ahn, MD, PhD

    Professor
    Chonnam National University Medical School
    Gwangju, Cholla-namdo, Republic of Korea

  • JL

    Jang Hoon Lee

    Professor
    School of Medicine, Kyungpook National University
    Dague, Taegu-jikhalsi, Republic of Korea

  • JK

    Ju-Seung Kwun

    Professor
    Seoul National University Medical School
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

  • Young-Hoon Jeong, MD, PhD

    Professor
    Chung-Ang University Gwangmyeong Hospital
    Gwangmyeong, Kyonggi-do, Republic of Korea

  • JH

    Joo-Yong Hahn

    Professor
    Sungkyunkwan University School of Medicine
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

  • JH

    Jin Yong Hwang

    Professor
    Gyeongsang National University Medical School
    Jinju, Kyongsang-namdo, Republic of Korea

  • WK

    Weon Kim

    Professor
    Kyung Hee University Hospital
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

  • MJ

    Myung Ho Jeong

    Professor
    Chonnam National University Medical School
    Gwangju, Kwangju-jikhalsi, Republic of Korea

Background: Data are limited regarding which target is better between the percentage reduction from baseline and fixed follow-up levels in low-density lipoprotein cholesterol (LDL-C) lowering therapy for patients with acute coronary syndrome.

Aims: We aimed to investigate associations between clinical outcomes and these two different targets in LDL-C lowering therapy after acute myocardial infarction using a nationwide Korean registry.

Methods: Out of 13,707 patients between November 2011 and December 2015, we identified 6930 patients who had LDL-C levels at baseline and during 18 months of follow-up. The co-primary outcomes were major adverse cardiovascular events (MACE; a composite of nonfatal stroke, nonfatal myocardial infarction, repeat revascularization, and all-cause death) and all-cause death at 5 years. Time-averaged LDL-C was defined as the cumulative LDL-C divided by the total duration between admission and 18 months.

Results: For analysis of follow-up LDL-C levels ( < 55, 55-69, 70-89, and ≥90 mg/dL), there was a U-shaped trend between follow-up LDL-C levels and clinical outcomes (6.5% vs 4.4% vs 4.0% vs 6.1% for all-cause death; P=0.001, and 11.0% vs 9.6% vs 10.1% vs 13.1% for MACE, P=0.005). For analysis of the LDL-C reduction rate from baseline, the greater the reduction, the better the clinical outcome. In a multivariable Cox time-to-event analysis with LDL-C < 50% reduction from baseline as the reference, >50% LDL-C reduction from baseline was independently associated with better clinical outcome (adjusted hazard ratio [HR], 0.68 for all-cause death; 95% confidence interval [CI], 0.50-0.91, and adjusted HR 0.76 for MACE; 95% CI, 0.62-0.92).

Conclusion(s): This nationwide Korean registry study of acute myocardial infarction demonstrated that the greater the LDL-C reduction from baseline, the better the clinical outcome, whereas there was a U-shaped trend between the follow-up LDL-C levels and clinical outcomes, supporting that percent reduction from baseline is a better target than fixed follow-up levels in LDL-C lowering therapy.