Key result
Implementation of the Kagoshima Style standardized lipid management pathway significantly reduced mean LDL-C levels from 113.3 mg/dL at admission to 69.2 mg/dL at 3 months in patients with acute coronary syndrome.
Why the study?
ACS mortality rates in Kagoshima Prefecture exceed the national average in Japan, reflecting challenges in lipid management and access to care.
Does a standardized regional lipid management pathway improve LDL-C control and guideline adherence in patients with acute coronary syndrome?
Cohort (n=1,184)
Yes
Does a standardized regional lipid management pathway improve LDL-C control and guideline adherence in patients with acute coronary syndrome?
Absolute Event Rate: 69.2% vs 113.3%
p-value: p=<0.0001
Implementation of a standardized regional lipid management pathway significantly improved LDL-C control and guideline adherence in ACS patients at 3 months.
Regional lipid pathways may improve post-ACS LDL-C control; leaves open whether they reduce events or apply beyond this registry.
BACKGROUND: With aging of the population, atherosclerotic diseases have increased in Japan, with acute coronary syndrome (ACS) a significant cause of morbidity and mortality. In Kagoshima Prefecture, ACS mortality rates exceed the national average, reflecting challenges in lipid management and access to care. METHODS AND RESULTS: The Optimal Therapy for All Kagoshima Acute Coronary Syndrome (OK-ACS) Registry, initiated in April 2022, enrolled 2,328 ACS patients across Kagoshima. This study evaluated the impact of a standardized lipid management pathway, the "Kagoshima Style," on low-density lipoprotein cholesterol (LDL-C) control and guideline adherence, as well as the regional profile of ACS in Kagoshima. The pathway was implemented at all percutaneous coronary intervention facilities to optimize lipid management and secondary prevention. LDL-C levels decreased significantly (P<0.0001) from admission to discharge and at 3 months (113.3±39.9, 74.6±28.0, and 69.2±25.9 mg/dL, respectively), with no difference according to place of residence. The proportion of patients with LDL-C <70 mg/dL increased from 12% at admission to 59% at 3 months. Maximum tolerated doses of high-intensity statin use increased from 7% at baseline to 9.3% after pathway implementation. Geographic disparities were evident, with patients from isolated islands experiencing delayed treatment access. CONCLUSIONS: The Kagoshima Style pathway improved lipid management, reducing LDL-C and enhancing guideline adherence. This interim analysis provides insights into lipid management and regional disparities in patients with ACS across Kagoshima prefecture.
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Kanda et al. (2025) conducted a cohort in Acute Coronary Syndrome (ACS) (n=1,184). Kagoshima Style standardized lipid management pathway vs. Baseline (admission) was evaluated on Mean LDL-C levels (mg/dL) (p=<0.0001). Implementation of the Kagoshima Style standardized lipid management pathway significantly reduced mean LDL-C levels from 113.3 mg/dL at admission to 69.2 mg/dL at 3 months in patients with acute coronary syndrome.
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