Optimal LDL-C Target in High-risk Patients After PCI

Inclusion criteria

• Patients underwent percutaneous coronary intervention due to acute or chronic coronary syndrome
• Patients with ASCVD at extremely high risk
• Patients who are able to complete the follow-up and compliant with the allocated treatment

• ASCVD at extremely high risk is defined as fulfilling at least TWO of the following criteria:

• PCI for acute myocardial infarction (AMI, including STEMI or NSTEMI)
• Previous AMI, previous stroke, or previous intervention or surgery for peripheral vascular disease
• Experienced cardiovascular event(s) with LDL-C≤1.8mmol/L
• LDL-C≥4.9mmol/L
• Diabetes
• CKD (eGFR < 60 ml/min/1.73m2)
• Current smoking
• Recurrent cardio/cerebrovascular events
• History of premature ASCVD (< 55 male, < 65 female)
• Complex PCI (fulfilling at least one of the following criteria: multivessel disease; in-stent restenosis; ≥ 3 stents implanted; total stent length ≥ 60 mm; bifurcation; left main disease; target lesions allocated in bypass graft; chronic total occlusion (≥ 3 months of occlusion))

Exclusion criteria

• Age less than 18 years;
• Unable to give informed consent or currently participating in other trials;
• Patient who is pregnant or nursing (a pregnancy test must be performed within 7 days prior to randomization in women of child-bearing potential according to local practice), or plans to become pregnant during treatment;
• Concurrent medical condition with a life expectancy of less than 3 years;
• Hemodynamic unstable;
• Active liver disease or hepatic dysfunction (persistent unexplained ALT/AST elevations (≥ 3 × ULN)), patients with a transient increase ALT/AST due to the acute MI may be enrolled;
• Unable to reach the LDL-C target by known intolerance or contradiction of lipid control medications;
• LDL-C ≤ 1.4 mmol/L at baseline without any lipid control medication lowering LDL-C;
• Known active infection or critical hematologic/endocrine dysfunction.