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Current treatment guidelines for acute myocardial infarction (AMI) recommend lowering low density lipoprotein cholesterol (LDL-C). However, previous clinical studies among East Asian AMI patients failed to prove its clinical efficacy of lipid lowering therapy based on Western target LDL-C level. Thus, the purpose of this study is directly to compare the clinical outcomes of target LDL-C 70 mg/dL and 55 mg/dL and identify optimal target LDL-C level and in Korean AMI patients.A total of 2198 AMI patients in Korea AMI Registry - National Institute of Health were enrolled. Patients were initially divided into LDL-C non-target group (n = 1115) and target group (n = 1083). Successful achievement of follow up target LDL-C was defined as70 mg/dL and ≥ 50% reduction from baseline. Target group patients were additionally divided to70 mg/dL group (n = 698) and55 mg/dL group (n = 385). Propensity score matching analysis was done in non-target vs. target group and70 mg/dL vs.55 mg/dL group. In the matched population, the risk of 3 years major adverse cardiac event (MACE) (13.0% vs 9.8%, HR: 0.73; 95% CI: 0.56-0.96; p = 0.025) was higher in non-target group patients. However, the risk of MACE was similar in70 mg/dL and 55 mg/dL group patients (10.0% vs 8.1%, HR: 0.75, 95% CI: 0.46-1.22; p = 0.247).In the present study, target LDL-C level of70 mg/dL and ≥ 50% reduction from baseline level was associated with better clinical outcomes in Korean AMI patients. However, further lowering target LDL-C level of55 mg/dL showed no additional benefits.

Mechanical dyssynchrony (MD) is associated with poor outcomes in many different populations. However, the predictors for the development of MD after chronic right ventricular (RV) pacing are not well known.Pacing QRS morphology and MD using echocardiography was analyzed in 175 consecutive patients that have pacemaker implantation during a 7.6 year median follow-up. Predictive score for MD was constructed using QRS morphology variables and calculated by summing the points of the 4 variables: duration (≥150 ms, 1 point), transition (1 point), notching (2 points), and left-axis deviation (1 point), based on a multivariate-adjusted risk relationship with MD.Sixty-eight (38.9%) patients developed MD. Patients with MD had worsened left ventricular systolic function (ejection fraction from 64.6±10.6% to 59.1±10.4%, p0.001) and heart failure symptoms (New York Heart Association functional class increase from 1.1±0.3 to 1.9±0.8, p0.001). In an electrocardiographic analysis, QRS duration≥150 ms, the presence of precordial axis transition, notching, and left-axis deviation were strongly associated with MD. Predictive score for MD using QRS morphology parameters displayed an excellent graded relationship with MD (score 0: 3.4% vs. 1: 12.5% vs. 2: 22.6% vs. 3: 45.0% vs. 4: 57.9% vs. 5: 72.7%, linear p0.001) (model performance c-static 0.78, 95% confidence interval 0.72-0.85, p0.001).Patients with MD experienced a decline in left ventricular systolic function and an increase in heart failure symptoms after chronic RV pacing. A new scoring system using QRS morphology is considered a simple and efficient tool for predicting the development of MD after chronic RV pacing.

Clinical impacts of high-sensitivity C-reactive protein reduction for secondary prevention in Asian patients with one-year survivor after acute myocardial infarction☆ Hyun Kuk Kim , Myung Ho Jeong ⁎, HyeongWon Seo , Joon Ho Ahn , Kyung Hoon Cho , Young Joon Hong , Ju Han Kim , Youngkeun Ahn , Jeong Gwan Cho , Jong Chun Park , Kyung Woo Park , Hyo-Soo Kim , Sang Rok Lee , Jei Keon Chae , Korea Acute Myocardial Infarction Registry Investigators

The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice.Of 3091 consecutive patients with AMI who had baseline LDL-C levels ≥ 70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (≥ 50% reduction, n=428 versus50% reduction, n=877) and fixed levels (70 mg/dL, n=625 versus ≥ 70 mg/dL, n=680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with50% LDL-C reduction from baseline, patients with ≥ 50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P=0.002). But, compared with LDL-C levels ≥ 70 mg/dL at 1 year, patients with LDL-C levels70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P=0.793).Obtaining a ≥ 50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a70 mg/dL was not.