Low-Density Lipoprotein Cholesterol Levels and Neoatherosclerosis After STEMI: A Secondary Analysis of the CONNECT Randomized Clinical Trial.

Achieving secondary preventive low-density lipoprotein cholesterol (LDL-C) target levels can reduce plaque progression in native coronary arteries; however, its association with neoatherosclerosis formation remains unclear.

达到次级预防的低密度脂蛋白胆固醇（LDL-C）目标水平可以减缓原发冠状动脉斑块的进展；然而，其与新生动脉粥样硬化形成之间的关联尚不明确。

Background

To determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation.

确定在药物洗脱支架植入后达到指南推荐的LDL-C水平是否与降低长期新发动脉粥样硬化形成风险相关。

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the CONNECT randomized clinical trial conducted at 7 sites in Switzerland and Japan that had randomized 239 patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) with biodegradable- or durable-polymer everolimus-eluting stents between June 2017 and June 2020.

设计、环境和参与者：这是在瑞士和日本7个地点进行的CONNECT随机临床试验的事后分析，该试验在2017年6月至2020年6月期间将239名ST段抬高型心肌梗死（STEMI）患者随机分为生物可降解或持久聚合物依维莫司洗脱支架的经皮冠状动脉介入治疗（PCI）。

The prevalenceof neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI.

通过光学相干断层扫描（OCT）评估了原发性经皮冠状动脉介入治疗（PCI）后3年的新生动脉粥样硬化的患病率。

Data analysis for this post hoc analysis was conducted from September 2024 to October 2025.

这项事后分析的数据分析工作是从2024年9月进行到2025年10月。

intervention

Patients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines.

接受直接经皮冠状动脉介入治疗（primary PCI）的ST段抬高型心肌梗死（STEMI）患者，根据各国特定指南推荐使用他汀类药物治疗。

main_outcomes_and_measures

The prevalenceof neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels.

比较了在直接经皮冠状动脉介入治疗（primary PCI）后3年，达到或未达到指南推荐的靶目标低密度脂蛋白胆固醇（LDL-C）水平的患者中新生动脉粥样硬化的患病率。

A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis.

进行了多变量预测分析，以确定治疗期间的低密度脂蛋白胆固醇（LDL-C）水平是否与新发动脉粥样硬化的发生有关。

Results

Among 178 patients (mean [SD] age, 63.4 [10.9] years; 27 [15%] female) who underwent OCT at 3 years, 98 patients (55%) achieved the target LDL-C level and 80 patients (45%) did not.

在178名患者中（平均年龄[标准差]为63.4[10.9]岁；女性27名[15%]），这些患者在3年时接受了光学相干断层扫描（OCT），其中98名患者（55%）达到了目标LDL-C水平，而80名患者（45%）未达到。

The mean (SD) on-treatment LDL-C levels for these groups were 48 (13) and 87 (37) mg/dL, respectively (to convert to millimoles per liter, multiply by 0.0259).

这些组的治疗期间平均（标准差）LDL-C水平分别为48（13）和87（37）mg/dL（要转换为毫摩尔/升，乘以0.0259）。

The prevalenceof neoatherosclerosis was lower in patients who achieved the target LDL-C level as compared with patients who did not (7 patients [7%] vs 15 patients [19%], respectively; odds ratio for those who did not achieve the LDL-C target level, 3.00; 95% CI, 1.19-8.24; P = .02).

达到目标LDL-C水平的患者中，新发动脉粥样硬化的患病率低于未达到目标的患者（分别为7名患者[7%]与15名患者[19%]；未达到LDL-C目标水平的患者的优势比为3.00；95%置信区间为1.19-8.24；P = .02）。

On-treatment LDL-C level (per 25-mg/dL increase) emerged as an independent determinant of neoatherosclerosis at 3 years in multivariable logistic regression analysis (odds ratio, 1.46; 95% CI, 1.09-2.01; P = .01).

在多变量逻辑回归分析中，治疗期间的LDL-C水平（每增加25 mg/dL）是3年内新发动脉粥样硬化的独立决定因素（比值比，1.46；95%置信区间，1.09-2.01；P = .01）。

conclusions_and_relevance

On-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI.

治疗期间的LDL-C水平是STEMI患者植入药物洗脱支架（DES）后3年新发动脉粥样硬化的独立预测因子。

Neoatherosclerosis was less frequent among patients who achieved the guideline-recommended on-treatment LDL-C level, underscoring the importance of LDL-C lowering in preventing neoatherosclerosis formation.

在达到指南推荐的治疗期间LDL-C水平的患者中，新发动脉粥样硬化的发生率较低，这强调了降低LDL-C在预防新发动脉粥样硬化形成中的重要性。

trial_registration

ClinicalTrials.gov Identifier: NCT03440801.

ClinicalTrials.gov注册号：NCT03440801。