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, Novara, Italy; Division of Cardiology, Maggiore della Carità Hospital, Novara, Italy.
Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
Int J Cardiol. 2025 Aug 15;433:133327. doi: 10.1016/j.ijcard.2025.133327. Epub 2025 Apr 29.
We retrospectively evaluated the impact on non-HDL-cholesterol (non-HDL-C) levels of the systematic introduction in our institution of an individualized, pre-defined, strike early and strong (SES) strategy for lipid-lowering therapy (LLT) in patients with acute myocardial infarction (MI).
We analyzed data from 500 consecutive patients admitted across three periods: Period A (N = 198, January-June 2019), when the non-HDL-C goal was <100 mg/dL and a stepwise LLT approach was indicated; Period B (N = 180, January-June 2021), when the non-HDL-C goal was <85 mg/dL and a stepwise approach was recommended; Period C (N = 122, January-June 2023), when the SES protocol was introduced. Primary endpoints were the percentage of patients reaching the non- HDL-C goal during follow-up and the incidence of major adverse cardiovascular events (MACE) at one year.
Compared to the other periods, the prevalence of prescription at discharge of potent statins, alone or in combination with ezetimibe, and PCSK9 inhibitors was greater in Period C. The achievement of the non-HDL-C goal in Period C was higher (87 % vs 67 % and 58 % in Periods A and B, respectively; p < 0.001). This achievement was associated with a lower occurrence of MACE (7 % vs. 13 % in patients not at target; log-rank p = 0.027). MACE incidence was the lowest in patients with early and sustained non-HDL-C < 85 mg/dL during follow-up.
The systematic introduction of an individualized, SES approach for LLT in patients with acute MI led to higher achievement of the non-HDL-C goal and this translated into a lower risk of MACE.
我们回顾性评估了在我院对急性心肌梗死（MI）患者系统性引入个体化、预先定义的早期强化降脂治疗（LLT）策略（SES）对非高密度脂蛋白胆固醇（non-HDL-C）水平的影响。
我们分析了连续三个时期收治的500例患者的数据：A期（N = 198，2019年1月至6月），当时non-HDL-C目标为<100 mg/dL，采用逐步LLT方法；B期（N = 180，2021年1月至6月），当时non-HDL-C目标为<85 mg/dL，推荐采用逐步方法；C期（N = 122，2023年1月至6月），引入了SES方案。主要终点是随访期间达到non-HDL-C目标的患者百分比以及1年时主要不良心血管事件（MACE）的发生率。
与其他时期相比，C期单独或联合依泽替米贝使用强效他汀类药物以及PCSK9抑制剂出院时的处方率更高。C期non-HDL-C目标的达成率更高（分别为87%，而A期和B期为67%和58%；p < 0.001）。这一达成率与较低的MACE发生率相关（未达目标的患者中为7% vs. 13%；对数秩检验p = 0.027）。随访期间早期且持续non-HDL-C < 85 mg/dL的患者MACE发生率最低。
对急性心肌梗死患者系统性引入个体化的SES降脂治疗方法导致non-HDL-C目标达成率更高，这转化为更低的MACE风险。
