AIMS: Considering the lack of evidence, we evaluated the impact on cardiovascular outcome of the systematic introduction in our institution of a personalized strike early and strong (SES) approach for lipid-lowering therapy (LLT) in patients admitted for acute myocardial infarction (MI). METHODS AND RESULTS: We retrospectively analysed data from 500 consecutive patients hospitalized across three periods: Period A (N = 198, January-June 2019), when the low-density lipoprotein cholesterol (LDL-C) goal was <
70 mg/dL and a stepwise LLT approach was recommended
Period B (N = 180, January-June 2021), when the LDL-C goal was <
55 mg/dL and a stepwise approach was recommended
Period C (N = 122, January-June 2023), when the LDL-C goal was <
55 mg/dL and our SES protocol was implemented. Primary endpoints were achievement of the LDL-C goal during follow-up and 1-year incidence of major adverse cardiovascular events (MACE). Compared to the other periods, in Period C, there was a higher use of potent statins, alone or in combination with ezetimibe, and of proprotein convertase subtilisin/kexin type 9 inhibitor inhibitors at discharge. This translated into higher achievement of the LDL-C goal (83% vs. 55% in Period A and 43% in Period B
P <
0.001) and reduced incidence of MACE (3% vs. 12% and 11%
P = 0.026). MACE rates were lowest in patients with early and sustained LDL-C <
55 mg/dL and in those achieving both LDL-C <
55 mg/dL and ≥50% LDL-C reduction. CONCLUSION: The systematic introduction of a personalized, SES strategy for LLT in patients with acute MI led to greater achievement of LDL-C goal and lower risk of MACE at 1 year vs. the stepwise approach.