Abstract 18304: Clinical Impact of Initial Reduction of Low-density Lipoprotein Cholesterol Level on Long-term Outcome of Acute Myocardial Infarction in the Statin Era
Background: In terms of secondary prevention of acute myocardial infarction (AMI), optimal period for achievement of target percent reduction of LDL-C level has not yet been well established.
Methods: The Assessment of Lipophilic vs. Hydrophilic Statin Therapy in AMI (ALPS-AMI) study enrolled a total of 508 patients (mean age, 66.0±11.6 years, 80.6% male) hospitalized for AMI. Of these patients, 248 patients achieved percent reduction of LDL-C ≧ 30% until 8 week after randomization, 204 patients achieved at 4 week (early reduction group), 44 patients achieved at 8week (late reduction group). The two groups were identified prospectively and analyzed with regard to the composite end point (MACE: all-cause death, myocardial infarction, stroke). We evaluated long term clinical outcomes of AMI patients after PCI in terms of the period for achievement of target percent reductions in LDL-C.
Results: MACE were significantly higher in the late reduction group compared to early reduction group (20.5% vs. 3.9 %, P<0.0001). The incidence of cardiac death were[[Unable to Display Character:  ]]significantly higher in the late reduction group than early reduction group (6.8% vs. 0.5%, P=0.003). In multivariate Cox proportional hazards analysis, percent reduction level of LDL-C during initial 4 week (HR, 0.93; 95% CI: 0.89-0.96, P<0.0001) and baseline LDL-C level (HR, 0.98; 95% CI: 0.96-0.99, P=0.038) predicted adverse events after adjustment for age.
Conclusions: The earlier reduction of LDL-C level is important for the patients with AMI in terms of reduction of ischemic events. We should reduce LDL-C level to target percent reductions for at least moderate-intensity statin therapy as early as 4 weeks after primary PCI in patients with AMI.
Author Disclosures: T. Miura: None. A. Izawa: None. H. Motoki: None. Y. Miyashita: None. Y. Kashima: None. T. Tomita: None. T. Tomita: None. J. Koyama: None. U. Ikeda: None.
- © 2014 by American Heart Association, Inc.