Achievement of target LDL-cholesterol level in patients with acute coronary syndrome undergoing percutaneous coronary intervention: The JET-LDL registry

Background: In patients with acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level < 1.4 mmol/L (<55 mg/dL). Methods: The JET-LDL is a multicenter, observational, prospective registry created to investigate levels of LDL-C in consecutive patients with ACS undergoing PCI at 35 Italian hospitals, and to report their lipid lowering therapies (LLT). Follow-up was planned at 1 and 3 months. LDL-C reduction >50% from baseline or level < 55 mg/dL at 1-month was the primary endpoint. Results: A total of 1095 patients were included: median age was 67 (58–75); 33.7% were already on LLT. Baseline LDL-C levels was 105 (76.5–137) mg/dL. At hospital discharge all patients were on LLT: 98.1% received statins (as mono or combination therapy), ezetimibe and PCSK9i were used in 60.1% and 8.5% of cases, respectively. Primary endpoint was achieved in 62% (95% CI 58–65) of cases. At 1-month LDL-C levels dropped to 53 (38–70) mg/dL (p < 0.001 vs baseline) and it was <55 mg/dL in 53% (95% CI 49–57) of patients; however, PCSK9i were added to 7 further cases. At 3-months 58% (95% CI 55–62) of patients achieved the target level, but PCSK9i was added to only 11 new patients. Conclusions: In this real-world registry of ACS patients undergoing PCI, recommend LDL-C levels were obtained in 62% of patients, but PCSK9i prescription was limited to 10% of cases. As LLT pattern appeared mainly improved at hospital discharge, an early and strong treatment should be considered.