{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T16:43:26Z","timestamp":1794069806338,"version":"4.8.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"\n Importance<\/jats:title>\n Neoatherosclerosis represents a major cause of late stent failure and results in cardiac events after drug-eluting stent (DES) implantation. 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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. The prevalence of neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI. Data analysis for this post hoc analysis was conducted from September 2024 to October 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The prevalence of neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels. A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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. 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). The prevalence of 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;\n P<\/jats:italic>\n \u2009=\u2009.02). 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;\n P<\/jats:italic>\n \u2009=\u2009.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n On-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI. 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03440801<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2025.4723","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T16:00:24Z","timestamp":1765987224000},"page":"137","source":"Crossref","is-referenced-by-count":5,"title":["Low-Density Lipoprotein Cholesterol Levels and Neoatherosclerosis After STEMI"],"prefix":"10.1001","volume":"11","author":[{"given":"Jonas Dominik","family":"H\u00e4ner","sequence":"first","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Kakizaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Taniwaki","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Ohno","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Yahagi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Osaka Police Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George C. M.","family":"Siontis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Stortecky","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuaki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Lanz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Ueki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiko","family":"Otsuka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio Giuseppe","family":"Biccir\u00e8","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, 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