The purpose of this study was to investigate the hypothesis that the achievement of LDL-C target values according to the guidelines after DES implantation was related to a decreased risk of neo-atherosclerosis development.
This study was a post-hoc analysis of the CONNECT randomized clinical trial performed in 7 centers in Switzerland and Japan. The primary study included patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with biodegradable-polymer or durable-polymer everolimus-eluting stents from June 2017 to June 2020. Optical coherence tomography (OCT) was employed to evaluate the incidence of neo-atherosclerosis in these patients 3 years following the initial PCIs. The analysis of the data was done from September 2024 to October 2025.
Of the originalRCT-based cohort, 178 patients actually underwent OCT imaging at 3 years. Mean age was 63.4 years (SD, 10.9 years); 15% of patients were female. All patients received DES in conjunction with primary PCI, and statin therapy was recommended according to country-specific guidelines. Patients were divided based upon achievement of guideline-recommended levels for LDL-C in follow-up.
The main endpoint was the prevalence of neoatherosclerosis identified by OCT at 3 years after DES implantation. Secondary analyses included the relationship between on-treatment levels of LDL-C and the development of neoatherosclerosis by multivariable logistic regression.
Key Findings
A total of 98 (55%) of 178 patients achieved target levels of LDL-C, whereas 80 (45%) did not.
The mean on-treatment values of LDL-C were 48 mg/dL (SD, 13) in those achieving targets and 87 mg/dL (SD, 37) in those not achieving targets.
Neoatherosclerosis developed in 7% of those achieving LDL-C targets compared with 19% of those not achieving targets.
Patients not achieving target levels of LDL-C had a threefold risk of neoatherosclerosis (odds ratio, 3.00; 95% CI, 1.19-8.24; P = 0.02).
Each 25-mg/dL rise in on-treatment values of LDL-C was independently related to the risk of neoatherosclerosis at 3 years (odds ratio, 1.46; 95% CI, 1.09-2.01; P = 0.01).
The attainment of target levels of LDL-C following DES implantation was independently related to a reduced prevalence of neoatherosclerosis at 3 years. The results support the central role of aggressive LDL-C lowering in a long-term approach to avert late stent thrombosis and optimize coronary outcomes in patients with STEMI.
Reference:
Häner JD, Kakizaki R, Taniwaki M, et al. Low-Density Lipoprotein Cholesterol Levels and Neoatherosclerosis After STEMI: A Secondary Analysis of the CONNECT Randomized Clinical Trial. JAMA Cardiol. Published online December 17, 2025. doi:10.1001/jamacardio.2025.4723
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