Choi WG, Baek MJ, Rha SW, et al. - In statin-naïve acute myocardial infarction (AMI) patients receiving percutaneous coronary intervention, a very low low-density lipoprotein (LDL) cholesterol level (<70 mg/dL) at admission was found to be independently linked with higher mortality at 24 months.

• In the Korea Acute Myocardial Infarction Registry, 8,741 (mean age: 64.6 ± 12.7 years, men) consecutive AMI patients treated with drug-eluting stents were enrolled from November 2011 to December 2015.

• Participants were split into six groups based on if they were using statins (on-statin group) or not (statin naïve group) and based on their LDL cholesterol level at admission (<70, 70–99, 100–129, 130–159, >160 mg/dl).

• With the increase of LDL cholesterol, lower incidence of risk factors including hypertension, diabetes, coronary artery disease and heart failure was noted, except in the on-statin group.

• Participants with high LDL cholesterol had better outcomes including total mortality at 24 months, vs those with low LDL cholesterol, except in the statin group.

• It was found in the statin-naïve group that the higher the LDL cholesterol concentration, the higher the rate of 24-month survival.

• Mortality at 24 months was independently predicted by initial low LDL cholesterol, post-adjusting for baseline confounding factors, in a Cox regression model.