Effect of hospital Intensive lipid-lowering protocol on low density lipoprotein cholesterol control and clinical outcomes in patients with acute myocardial infarction

Abstract Background Atherosclerotic cardiovascular disease remains a leading cause of death worldwide. Although lipid lowering therapy has contributed to reduction of cardiovascular events, control of low-density lipoprotein cholesterol (LDL-C) levels is still suboptimal. We investigated whether an intensive hospital lipid-lowering protocol is effective on lipid management of LDL-C levels, and subsequently cardiovascular events in patients with acute myocardial infarction (AMI). Methods A total of 571 AMI patients who underwent percutaneous coronary intervention (PCI) at our pharmaceutical university from 2014 to 2023 were analyzed retrospectively. Our intensive lipid-lowering protocol which recommends maximum tolerated dose of statins, ezetimibe and PCSK9 inhibitor for AMI patients, was introduced in June 2018. Lipid profiles and clinical outcomes were evaluated and compared between before and after the protocol. The primary outcomes were attainment rate of LDL-C levels 55 mg/dl, changes of LDL-C levels from admission to 12 months after PCI and incidence of major adverse cardiovascular events (MACE), including non-fatal myocardial infarction, stent thrombosis, target vessel revascularization, and cardiovascular death. Results In the present study, 162 subjects were in the control group and 409 subjects in the protocol group. LDL-C level was significantly lower and attainment rate of LDL-C 55 mg/dL was higher in the protocol group than in the control group (62.3 mg/dL vs. 87.0 mg/dL, p 0.001, 45.7% vs. 8.0%, p 0.001, respectively). A Kaplan-Meier analysis comparing the 5-year incidence of MACE showed a significantly lower event rate of the protocol group compared to the control group (Log-rank test: HR = 1.89, 95%CI: 1.17-3.02, p = 0.007). A Cox proportional hazards model was analyzed considering age, sex, diabetes (DM), smoking, and protocol implementation. The results showed that protocol implementation was independently associated with event occurrence (HR: 2.01, 95% CI: 1.24–3.23, P-value = 0.004). Conclusion Implementation of the intensive hospital lipid-lowering protocol effectively improved LDL-C control and reduced cardiovascular events in patients with AMI. Addition to pharmacotherapy, non-pharmacotherapy strategy of lipid lowering therapy is another potential to prevent cardiovascular events in the secondary prevention setting.