Related Experiment Videos

Cardiovascular Outcomes in Response to Achieved LDL-C Levels After PCI in ACS and CCS

Yu Kataoka1, Stephen J Nicholls2, Kausik K Ray3

  • 1Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan.

JACC. Asia
|July 20, 2026
PubMed

Insights

Patients with acute coronary syndrome (ACS) benefit more from intensive LDL-C control than those with chronic coronary syndrome (CCS). Achieving lower LDL-C levels significantly reduces major adverse cardiovascular events (MACE) in ACS patients.

Area of Science:

  • Cardiology
  • Preventive Cardiology
  • Lipid Management

Background:

  • Acute coronary syndrome (ACS) carries higher risks of recurrent atherosclerotic cardiovascular disease (ASCVD) than chronic coronary syndrome (CCS).
  • Current guidelines recommend uniform low-density lipoprotein cholesterol (LDL-C) goals for both ACS and CCS.
  • Intensified preventive management, particularly LDL-C control, is crucial for ACS patients.

Purpose of the Study:

  • To compare cardiovascular outcomes between ACS and CCS patients after achieving guideline-recommended LDL-C control.
  • To evaluate the impact of different achieved LDL-C levels on major adverse cardiovascular events (MACE).

Main Methods:

  • A multicenter retrospective observational study (ACTION-LDLC) analyzed 2560 Japanese patients with coronary artery disease (CAD).
  • Patients were categorized into ACS (n=1682) and CCS (n=878) groups.
  • Risk of MACE (cardiac death, non-fatal MI, non-culprit coronary revascularization) was assessed based on achieved LDL-C levels (<55, 55-69, ≥70 mg/dL) 8 weeks post-PCI.

Main Results:

  • LDL-C <55 mg/dL was achieved in 29.4% of ACS and 32.5% of CCS patients.
  • Lower achieved LDL-C levels were associated with reduced MACE risk in both ACS (p<0.001) and CCS (p=0.040).
  • ACS patients achieving LDL-C <55 mg/dL had significantly lower standardized 3-year MACE rates (4.4% vs. 9.9% in CCS) and greater absolute risk reductions compared to CCS.
  • In ACS patients with LDL-C <55 mg/dL, achieving LDL-C <40 mg/dL further reduced MACE risk (log-rank p=0.017).
  • Patients failing to achieve LDL-C <70 mg/dL showed substantially increased MACE risk in ACS compared to CCS (30.9% vs. 15.2%).

Conclusions:

  • Distinct cardiovascular risk profiles exist concerning LDL-C control in ACS versus CCS.
  • Achieving stricter LDL-C goals, potentially below <55 mg/dL or even <40 mg/dL, may be particularly important for reducing MACE in ACS patients.
  • Current uniform LDL-C guidelines may not be optimal for differentiating risk stratification and management intensity between ACS and CCS.
Abstract

Keywords:
acute coronary syndromeatherosclerotic cardiovascular diseasechronic coronary syndromelow-density lipoprotein cholesterol

Related Concept Videos

Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...