Achieved lipid levels and long-term myocardial perfusion assessed by serial CZT-SPECT in post-PCI anterior myocardial infarction.

PURPOSE: This study aimed to investigate the association between achieved lipid levels, as an indicator of lipid residual risk, and longitudinal changes in myocardial perfusion and function in patients with acute anterior myocardial infarction (AMI) after percutaneous coronary intervention (PCI), using serial rest-stress CZT-SPECT imaging.

METHODS

In this retrospective cohort study, 462 anterior AMI patients post-PCI were categorized by their mean follow-up lipid levels into three groups: double-target achievement (LDL-C ≤ 1.4 mmol/L and reduction ≥ 50%; non-HDL-C < 2.2 mmol/L), single-target achievement (met LDL-C target only), and non-achievement. Myocardial perfusion was assessed by regadenoson stress/rest CZT-SPECT (D-SPECT camera) at 7 days and 12 months. Parameters included myocardial perfusion score (MPS), ischemic segment count, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume (LVEDV). Major adverse cardiovascular events (MACE) were recorded.

RESULTS

The double-target group had significantly higher PCSK9 inhibitor use (66.0%) than the single-target (48.1%) and non-achievement groups (23.0%, P < 0.001). At 12 months, this group exhibited a lower MACE incidence (8.1% vs. 13.3% and 22.4%, P = 0.001), driven by reduced angina. Multivariable Cox regression confirmed that double-target achievement was independently associated with lower MACE risk (HR 0.38, P = 0.014) after adjusting for PCSK9 inhibitor use. Longitudinally, the double-target group showed the greatest improvement in MPS (ΔMPS - 5.0 ± 2.1) and LVEF compared to other groups (P < 0.001).

CONCLUSION

Achieving stringent dual lipid targets post-PCI is associated with improved long-term myocardial perfusion, attenuated adverse remodeling, and lower MACE incidence. While these benefits are linked to intensive lipid-lowering therapy including PCSK9 inhibitors, achieving lipid targets remains an independent predictor of improved outcomes.