The Clinical Outcome of Target Low Density Lipoprotein-Cholesterol (LDL-C) Achievement in Patients with Acute Myocardial Infarction: A Propensity Score Matched Analysis.

초록

Background: There is a limited data that clinical outcome difference of patient with or without achievement of target LDL-C in acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). We investigated whether target LDL-C levels (below 70 mg/dL) achievement in patients with AMI showed better clinical outcome or not. Methods: This study enrolled 13,473 AMI patients in a large-scale, prospective, multicenter Korean Acute Myocardial Infarction Registry (KorMI) between May 2008 and Sep 2012. 12,720 patients survived and 6,746 patients completed 1-year clinical follow up. Among them 3,315 patients received LDL-C follow up. Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, producing a total of 1,292 patients (646 target LDL-C achievers, vs. 646 nonachievers). The primary end point was the composite of 1-year major adverse cardiac events (MACEs) including cardiac death, recurrent myocardial infarction (MI), target lesion revascularization (TLR) and coronary artery bypass grafting (CABG). Results: After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. Clinical outcomes of the propensity score matched patients showed that no significant differences in cardiac death (0.5% vs. 0.5%, p=NS), recurrent MI (1.1% vs. 0.8%, p=NS), TLR (5.0% vs. 4.5%, p=NS), MACEs (6.5% vs. 5.9%, p=NS) and stent thrombosis (2.5% vs. 1.9%, p=NS). Conclusion: In this propensity-matched comparison, target LDL-C achievement in AMI patients undergoing PCI did not show the better clinical outcomes.