title: Comparison of the effects of two low-density lipoprotein cholesterol goals for secondary prevention after acute myocardial infarction in real-world practice: ≥ 50% reduction from baseline versus <70 mg/dL.
abstract: BACKGROUND
  The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice.
  
  
  RESULTS
  Of 3091 consecutive patients with AMI who had baseline LDL-C levels ≥ 70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (≥ 50% reduction, n=428 versus <50% reduction, n=877) and fixed levels (< 70 mg/dL, n=625 versus ≥ 70 mg/dL, n=680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with <50% LDL-C reduction from baseline, patients with ≥ 50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P=0.002). But, compared with LDL-C levels ≥ 70 mg/dL at 1 year, patients with LDL-C levels < 70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P=0.793).
  
  
  CONCLUSIONS
  Obtaining a ≥ 50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a < 70 mg/dL was not.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Kyung Hoon
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.affiliation: Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Chonbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Sang Rok
authors.initials: SR
authors.lastname: Lee
authors.affiliation: Chonbuk National University Hospital, Jeonju, Republic of Korea.
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D006040:Goals; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cholesterol; Myocardial infarction; Prevention; Statins