Key result
Achieving a rapid reduction of LDL-C levels by ≥30% within 4 weeks after acute myocardial infarction was associated with a significantly lower incidence of major adverse cardiovascular events compared to late reduction (3.4% vs. 9.4%).
Why the study?
Does rapid reduction of LDL-C (≥30% within 4 weeks) improve MACE in patients with AMI undergoing PCI?
Cohort (n=427)
Open-label
Yes
Does rapid reduction of LDL-C (≥30% within 4 weeks) improve MACE in patients with AMI undergoing PCI?
Achieving a rapid reduction of LDL-C levels by ≥30% within 4 weeks of AMI is associated with a significantly lower risk of major adverse cardiovascular events.
Answers are grounded in this paper and cite their sources.
May support rapid post-MI LDL-C reduction; leaves open causality and needs RCT confirmation.
BACKGROUND: The optimal period to achieve target percent reduction of low-density lipoprotein cholesterol (LDL-C) level for secondary prevention of acute myocardial infarction (AMI) is not well established. METHODS: The Assessment of Lipophilic vs. Hydrophilic Statin Therapy in AMI (ALPS-AMI) study enrolled 508 patients (mean age, 66.0± 11.6 years; 80.6% male) who were hospitalized for AMI and underwent percutaneous coronary intervention (PCI). Of these patients, 81 were excluded because of the absence of LDL-C measurements at 4 weeks after randomization. In the remaining 427 patients, the target LDL-C level reduction of ≥30% was achieved and not reached within 4 weeks after randomization in 204 cases (early reduction group) and 223 cases (late reduction group). The groups were formed prospectively and analyzed with regard to the composite end point (major adverse cardiovascular event [MACE]: all-cause death, myocardial infarction, and stroke) and clinical outcomes. RESULTS: MACE were significantly more frequent in the late reduction group compared to the early reduction group (9.4% vs. 3.4%, P = 0.013). The incidence of cardiac deaths was also significantly higher in the late reduction group (3.1% vs. 0.5%, P = 0.044). On age-adjusted Cox proportional hazards analysis in statin-naïve patients, percent reduction of LDL-C level during the initial 4 weeks (HR, 0.98; 95% CI: 0.97-0.99, P = 0.042) and baseline LDL-C level (HR, 0.98; 95% CI: 0.97-0.99, P = 0.033) predicted adverse events. CONCLUSIONS: Rapid reduction of LDL-C level is strongly associated with favorable outcome in patients with AMI.
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Miura et al. (2015) conducted a cohort in Acute Myocardial Infarction (AMI) (n=427). Early reduction of LDL-C level (≥30% reduction within 4 weeks) vs. Late reduction of LDL-C level (<30% reduction within 4 weeks) was evaluated on Major adverse cardiovascular events (MACE: composite of all-cause death, myocardial infarction, and stroke) (p=0.013). Achieving a rapid reduction of LDL-C levels by ≥30% within 4 weeks after acute myocardial infarction was associated with a significantly lower incidence of major adverse cardiovascular events compared to late reduction (3.4% vs. 9.4%).
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