Abstract 4368960: High-Intensity Statin Therapy Improves Outcomes Even After LDL-C Goal Achievement in Chronic Coronary Syndrome

Introduction: Current guidelines recommend a "treat to target" approach for lipid-lowering therapy in patients with chronic coronary syndrome (CCS), achieving the low-density lipoprotein cholesterol (LDL-C) levels target based on individual patient risk. However, it remains unclear whether the use of high intensity statins or non-high intensity statins to achieve the LDL-C goal in patients with CCS after percutaneous coronary intervention (PCI). Aim: We investigated the association between statin intensity and cardiovascular outcomes in patients who achieved LDL-C targets after PCI. Methods: A total of 455 Japanese patients with CCS who achieved an LDL-C level < 70mg/dL after PCI were enrolled. We divided patients into 4 groups according to the LDL-C levels and statin intensity prescribed after PCI: LDL-C < 55mg/dL with high intensity statins group (n = 81), LDL<55mg/dL with non-high intensity statins group (n = 170), LDL 55-70 mg/dL with high intensity statins group (n = 55), and LDL 55-70 mg/dl with non-high intensity statins group (n = 149). High-intensity statins were defined as the maximum approved doses of strong statins in Japan. Cardiovascular outcomes were defined as a composite of cardiovascular events, including cardiovascular death, acute coronary syndrome, stroke, and revascularization. Results: The mean age of the current study population was 73 years, and 75% were male. Among both achieved LDL-C goal groups, there was no significant difference in LDL-C levels between high intensity statins group and non-high intensity statins group (LDL-C < 55mg/dL: 43 ± 9 mg/d L vs. 43 ± 9 mg/d L; LDL-C 55-70 mg/d L: 62 ± 4 mg/d L vs. 61 ± 4 mg/d L). Kaplan-Meier survival analysis revealed a significantly lower incidence of cardiovascular events in the high intensity statins groups than the non-high intensity statins groups (log-rank test < 0.02) (Figure). Conclusions: Among patients with CCS who achieved LDL-C goal after PCI, high-intensity statin therapy was associated with a lower incidence of major adverse cardiovascular events compared to non-high-intensity statin therapy, regardless of the achieved LDL-C level.