Background: The effects of aggressive
lipid-lowering
therapy according to the number of diseased coronary arteries in
acute coronary syndrome (ACS) are still controversial. This study investigated the efficacy of this
therapy in ACS patients with multivessel disease (MVD) and single-vessel disease (SVD). Methods and Results: The subjects were derived from the HIJ-PROPER study, in which ACS patients with
dyslipidemia were randomized to receive either pitavastatin+ezetimibe (targeting
low-density lipoprotein cholesterol [
LDL-C] <70 mg/dL) or
pitavastatin monotherapy (targeting
LDL-C <90 mg/dL). In this study, treatment efficacy was compared between patients with MVD and SVD. The primary endpoint was a composite of major advanced cardiovascular events (
MACE; all-cause death, non-fatal
myocardial infarction, non-fatal
stroke, and
ischemia-driven revascularization). We identified 1,702 eligible patients (MVD, n=869; SVD, n=833; mean age, 65.6 years; male, 75.6%; acute revascularization, 96.2%).
MACE incidence was significantly higher in the MVD group than in the SVD group (43.7% vs. 25.9%, HR, 1.95; 95% CI: 1.65-2.31, P<0.001). In the SVD group, pitavastatin+ezetimibe had significantly fewer
MACE than
pitavastatin monotherapy (34.6% vs. 47.4%, HR, 0.72; 95% CI: 0.55-0.94, P=0.02). Conclusions: The benefits of aggressive
lipid-lowering
therapy, with the addition of
ezetimibe to
statins, were enhanced in ACS patients with SVD, but not with MVD, in the early invasive strategy era.