Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese · 2026
LDL-C Target Attainment and Treatment Gaps Six Months After Acute Coronary Syndrome: insights from the CALLINICUS-Hellas registry.
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Rallidis Loukianos S, Tsamoulis Donatos, Benetou Despoina-Rafailia, Bouratzis Vasileios, Papapanou Michail, Tasoulas Dimitrios, Lykoudis Anastasios, Kalogeras Petros, Daios Stylianos, Leventis Ioannis, Malkots Belkis, Kakouri Niki, Roussos Christos, Ntalaoutis Andreas, Sianis Alexandros, Tsantikidi Zinovia, Potoupni Victoria, Kalantzis Charalampos, Rallidis Stylianos L, Platis Dimitrios, Panagiotakos Demosthenes, Vlachopoulos Charalambos
Аннотация
BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) reduction is the cornerstone of secondary prevention after acute coronary syndrome (ACS). Despite potent lipid-lowering therapies (LLTs), a therapeutic gap persists. We aimed to evaluate LDL-C target attainment according to the 2019 ESC/EAS guidelines, identify predictors of treatment failure, and simulate the impact of treatment intensification.
METHODS: The CALLINICUS-Hellas registry is a prospective, multicenter study of patients with ACS. LDL-C target attainment at 6 months, defined as LDL-C reduction ≥50% from baseline and an LDL-C <55 mg/dL, was assessed. Simulation modeling explored four guideline-recommended LLT intensification scenarios. Hierarchical cluster analysis aimed to identify patient phenotypes associated with goal attainment.
RESULTS: Among 1,947 patients, 37.9% achieved LDL-C target at 6 months. The main driver of treatment failure was clinical inertia, with <1% of patients receiving PCSK9 inhibitors at follow-up. Persistent smoking at 6 months, lipoprotein(a) >70 mg/dL, higher untreated LDL-C levels and heterozygous familial hypercholesterolemia were associated with treatment failure while high-intensity statin (HIS) ± ezetimibe (EZE) at discharge was the most prominent predictor of treatment attainment (all p-values <0.05). Cluster analysis confirmed that target attainment depended on discharge LLT intensity, not clinical phenotypes. Simulation analysis showed that universal HIS ± EZE at discharge could increase target attainment to 51%, whereas optimal triple LLT (HIS + EZE + PCSK9 inhibitors) could increase it to 97.7%.
CONCLUSIONS: Despite progress, LDL-C target attainment after ACS remains suboptimal, largely due to clinical inertia and guideline-recommended LLT underuse. Early initiation of combination LLT after ACS could substantially improve target attainment.
METHODS: The CALLINICUS-Hellas registry is a prospective, multicenter study of patients with ACS. LDL-C target attainment at 6 months, defined as LDL-C reduction ≥50% from baseline and an LDL-C <55 mg/dL, was assessed. Simulation modeling explored four guideline-recommended LLT intensification scenarios. Hierarchical cluster analysis aimed to identify patient phenotypes associated with goal attainment.
RESULTS: Among 1,947 patients, 37.9% achieved LDL-C target at 6 months. The main driver of treatment failure was clinical inertia, with <1% of patients receiving PCSK9 inhibitors at follow-up. Persistent smoking at 6 months, lipoprotein(a) >70 mg/dL, higher untreated LDL-C levels and heterozygous familial hypercholesterolemia were associated with treatment failure while high-intensity statin (HIS) ± ezetimibe (EZE) at discharge was the most prominent predictor of treatment attainment (all p-values <0.05). Cluster analysis confirmed that target attainment depended on discharge LLT intensity, not clinical phenotypes. Simulation analysis showed that universal HIS ± EZE at discharge could increase target attainment to 51%, whereas optimal triple LLT (HIS + EZE + PCSK9 inhibitors) could increase it to 97.7%.
CONCLUSIONS: Despite progress, LDL-C target attainment after ACS remains suboptimal, largely due to clinical inertia and guideline-recommended LLT underuse. Early initiation of combination LLT after ACS could substantially improve target attainment.