Abstract 12837: Studies of Suboptimal Low Density Lipoprotein Reduction Following Lipid Lowering Therapy on Cardiovascular Outcomes in Patients With Acute Coronary Syndrome

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Introduction: Current guidelines advocate achieving a fixed LDL-C target and attaining a more than half reduction of LDL-C levels. As the heterogeneity of response to lipid lowering therapy, effective LDL-C reduction is not achieved even in patients achieved a fixed LDL-C target. Aims: This study ought to investigate the clinical impact of suboptimal LDL-C reduction following lipid lowering therapy on cardiovascular outcomes in patients with acute coronary syndrome. Methods: A total of 561 consecutive ACS patients undergone PCI with measurement of LDL-C levels at the index of admission and 12 months after PCI were enrolled in the study. Based on the current guidelines, <50% LDL-C reduction within 12 months were defined as suboptimal LDL-C reduction. The relationship between the suboptimal LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel reperfusion, and stent thrombosis was evaluated. Results: In the current study, under the use of lipid-lowering therapies (statin: 84.1 %; high intensity statin: 18.9 %, ezetimibe: 24.8 % and PCSK9 inhibitor: 1.2 %), 24.6 % of study population exhibited LDL-C <1.4 mmol/L at 12 month after the index of PCI and 24.2 % achieved more than half reduction of LDL-C within 12 months. There were no significant differences in cardiovascular events between 2 groups according to LDL-C < 1.4 mmol/L (23.2 % - 17.4 %, P = 0.15), whereas the MACEs were higher in the suboptimal reduction group than the optimal reduction group (24.9 % - 11.8 %, P= 0.007). Of note, even in patients with LDL-C <1.4 mmol/L, the MACEs were highly observed in the suboptimal reduction group than the optimal reduction group (25.0 % - 12.4 %, P= 0.04). Multivariate analysis adjusting baseline LDL-C, HbA1c, sex and age revealed that suboptimal LDL-C reduction was an independent predictor of cardiovascular outcomes (HR: 0.7, 95% CI: 0.49-0.90). Conclusions: In addition to a fixed LDL-C target, more than half reduction of LDL-C following lipid lowering therapy is another relevant potential to reduce cardiovascular outcomes in patients with ACS.