Patti Giuseppe, Cumitini Luca, Bosco Manuel, Marengo Alessandra, D'Amario Domenico, Mennuni Marco, Solli Martina, Grisafi Leonardo
Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy.
Division of Cardiology, Maggiore della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy.
Eur Heart J Cardiovasc Pharmacother. 2025 Mar 13;11(2):143-154. doi: 10.1093/ehjcvp/pvaf004.
Considering the lack of evidence, we evaluated the impact on cardiovascular outcome of the systematic introduction in our institution of a personalized strike early and strong (SES) approach for lipid-lowering therapy (LLT) in patients admitted for acute myocardial infarction (MI).
We retrospectively analysed data from 500 consecutive patients hospitalized across three periods: Period A (N = 198, January-June 2019), when the low-density lipoprotein cholesterol (LDL-C) goal was <70 mg/dL and a stepwise LLT approach was recommended; Period B (N = 180, January-June 2021), when the LDL-C goal was <55 mg/dL and a stepwise approach was recommended; Period C (N = 122, January-June 2023), when the LDL-C goal was <55 mg/dL and our SES protocol was implemented. Primary endpoints were achievement of the LDL-C goal during follow-up and 1-year incidence of major adverse cardiovascular events (MACE). Compared to the other periods, in Period C, there was a higher use of potent statins, alone or in combination with ezetimibe, and of proprotein convertase subtilisin/kexin type 9 inhibitor inhibitors at discharge. This translated into higher achievement of the LDL-C goal (83% vs. 55% in Period A and 43% in Period B; P < 0.001) and reduced incidence of MACE (3% vs. 12% and 11%; P = 0.026). MACE rates were lowest in patients with early and sustained LDL-C <55 mg/dL and in those achieving both LDL-C <55 mg/dL and ≥50% LDL-C reduction.
The systematic introduction of a personalized, SES strategy for LLT in patients with acute MI led to greater achievement of LDL-C goal and lower risk of MACE at 1 year vs. the stepwise approach.
鉴于缺乏相关证据，我们评估了在我院对急性心肌梗死（MI）患者系统性采用早期强效个性化（SES）降脂治疗（LLT）方法对心血管结局的影响。
我们回顾性分析了连续三个时期住院的500例患者的数据：A期（N = 198，2019年1月至6月），当时低密度脂蛋白胆固醇（LDL-C）目标为<70 mg/dL，并推荐逐步LLT方法；B期（N = 180，2021年1月至6月），当时LDL-C目标为<55 mg/dL，并推荐逐步方法；C期（N = 122，2023年1月至6月），当时LDL-C目标为<55 mg/dL并实施了我们的SES方案。主要终点是随访期间LDL-C目标的达成情况以及1年主要不良心血管事件（MACE）的发生率。与其他时期相比，在C期，出院时单独或与依泽替米贝联合使用强效他汀类药物以及前蛋白转化酶枯草溶菌素/kexin 9型抑制剂的使用率更高。这转化为更高的LDL-C目标达成率（83% 对比A期的55%和B期的43%；P < 0.001）以及MACE发生率降低（3% 对比12%和11%；P = 0.026）。在早期和持续LDL-C <55 mg/dL的患者以及LDL-C <55 mg/dL且LDL-C降低≥50%的患者中，MACE发生率最低。
与逐步方法相比，对急性MI患者系统性采用个性化的SES LLT策略在1年时能使LDL-C目标达成率更高且MACE风险更低。
