# LDL-cholesterol en neoatherosclerose na STEMI: secundaire analyse

*geplaatst 2026-02-01 · Cholesterol · JAMA cardiology · doi 10.1001/jamacardio.2025.4723 · https://hartvaat.nl/2026/02/01/ldl-cholesterol-en-neoatherosclerose-na-stemi-secundaire-analyse/*

Analyse toonde dat lagere LDL-waarden minder neoatherosclerose in stents veroorzaken na STEMI. Intensieve LDL-verlaging beschermt niet alleen natieve vaten maar ook gestente segmenten.

## English: Low-Density Lipoprotein Cholesterol Levels and Neoatherosclerosis After STEMI: A Secondary Analysis of the CONNECT Randomized Clinical Trial.

This CONNECT secondary analysis confirmed that achieving lower LDL cholesterol levels reduces neoatherosclerosis formation within drug-eluting stents after STEMI, demonstrating that intensive lipid lowering protects against late stent failure.

## Abstract (original, from the publication)

IMPORTANCE: 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. OBJECTIVE: To determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: Patients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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; P = .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; P = .01). CONCLUSIONS AND RELEVANCE: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03440801.

Auteurs: Jonas Dominik Häner, Ryota Kakizaki, Masanori Taniwaki, Yohei Ohno, Kazuyuki Yahagi, Yoshiharu Higuchi, George C M Siontis, Kenji Ando, Stefan Stortecky, Nobuaki Suzuki, Naoki Watanabe, Jonas Lanz, Yasushi Ueki, Tatsuhiko Otsuka, Flavio Giuseppe Biccirè, Masami Sakurada, Konstantinos C Koskinas, Sylvain Losdat, Lorenz Räber

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Bron: JAMA cardiology, https://doi.org/10.1001/jamacardio.2025.4723. Bijgewerkt 2026-07-03T13:31:08Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.