Low-density lipoprotein-cholesterol (LDL-C)-lowering treatments help decrease the likelihood of developing neoatherosclerosis, including patients with coronary stents, a secondary analysis of the CONNECT trial shows. Jonas Dominik Häner, MD, from the Bern University Hospital, Switzerland, and colleagues, reported the corresponding data in a manuscript published online in JAMA Cardiology. Corresponding author Lorenz Räber, MD, PhD, also from the Bern University Hospital, spoke with CRTonline regarding the results of the study. “This is the first prospective study ever conducted associating directly on treatment LDL-C levels and new formation of atherosclerosis (neoatherosclerosis) inside stents,” Dr. Räber said. Late stent failure and cardiac events after drug-eluting stent (DES) implantation can be frequently caused by neoatherosclerosis. Secondary preventative measures, such as lowering LDL-C levels, may improve cardiac outcomes as well as lower plaque levels in patients with implanted stents. The CONNECT randomized, open-label, multicenter clinical trial examined 239 patients with ST-segment myocardial infarction (STEMI) who developed neoatherosclerosis and underwent primary percutaneous coronary intervention (PCI) with either biodegradable- or durable-polymer everolimus-eluting stents. Participants were randomized to the two stent types. This post-hoc analysis assessed how many patients from the CONNECT trial had neoatherosclerosis 3 years post-PCI using optical coherence tomography (OCT). Patients in this present study either did or did not receive achievement of guideline-endorsed target LDL-C levels. A total of 178 patients (mean age=63.4 years, 15% female) underwent OCT at 3 years post-PCI and 55% of them met the target LDL-C levels. Patients who met the target LDL-C levels had lower rates of neoatherosclerosis compared with patients who did not (7 vs 15 patients; odds ratio [OR] for those who didn’t meet LCL-C levels=3.00; 95% confidence interval [CI]=1.19-8.24; p=0.02). On-treatment LCL-C levels independently predicted neoatherosclerosis 3-years post-PCI (multivariable logistic regression analysis: OR=1.46; 95% CI=1.09-2.01; p=0.01). “This prospective intracoronary imaging study suggests that being on target with LDL cholesterol does not only prevent disease progression in the untreated coronary segments but also inside coronary stents,” Dr. Räber told CRTonline. “Our findings indicate how important low cholesterol is to keep the stents free from new atherosclerosis during the longer term.” Source: Häner JD, Kakizaki R, Taniwaki M, et al. Low-density lipoprotein cholesterol levels and neoatherosclerosis after STEMI: A secondary analysis of the CONNECT randomized clinical trial. JAMA Cardiol. 2025 December (Article in Press). Image Credit: teguhjatipras – stock.adobe.com