CONGRESS ABSTRACT

Background – The management of dyslipidemia is a cornerstone of secondary prevention in acute coronary syndrome (ACS). Current ESC Guidelines recommend a stepwise approach, progressively adding therapies based on prior treatments and baseline LDL-C levels. However, recent evidence highlights the benefits of systematic, early combination therapy in achieving faster and more consistent LDL-C reductions, improving both acute and long-term outcomes. This project implemented a shared workflow to ensure uniform treatment strategies across our department.   Methods – From June to November 2024, ACS patients were consecutively enrolled and categorized as therapy-naïve or pretreated. No patients were identified as statin-intolerant. Therapy-naïve patients were stratified by cardiovascular risk, with extreme risk defined by multivessel disease, peripheral or cerebrovascular atherosclerosis, or recurrent vascular events. LDL-C goals were <55 mg/dL for very-high-risk patients and <40 mg/dL for extreme-risk patients. Naïve patients received high-intensity statins and ezetimibe, initiated before PCI. PCSK9 inhibitors were added when needed based on risk and baseline LDL-C. Pretreated patients had their therapies optimized through titration of statin intensity and/or the addition of ezetimibe or PCSK9 inhibitors.    Results – A total of 105 patients were included (mean LDL-C 96.6 mg/dL): 44 (42%) were pretreated, and 61 (58%) were therapy-naïve, including 26 at extreme risk. Statin monotherapy decreased from 28.6% at admission to 5.7% at discharge. Dual therapy increased from 12.4% to 79%, and triple therapy rose from 0.9% to 15.2%. At one-month follow-up (48.6% of patients), 70.6% achieved LDL-C targets (mean LDL-C: 40.5 mg/dL vs. 94.1 mg/dL at admission).   Discussion – This study supports the “Strike Early, Strike Strong” strategy, emphasizing early, intensive LDL-C lowering after ACS. The structured workflow allowed tailored, evidence-based management, achieving consistent LDL-C reductions. Challenges included limited follow-up data, regional restrictions on PCSK9 inhibitor prescriptions, and difficulties in monitoring adherence. Nevertheless, this initiative demonstrates the feasibility of applying uniform strategies to improve outcomes, providing a replicable model for other centers.   Conclusion – Despite limitations, this project highlights the importance of structured workflows in ACS management, paving the way for future studies on long-term outcomes.