Would you routinely initiate a high-intensity statin before discharge in an elderly patient presenting with a STEMI s/p revascularization who has an LDL below 70 mg/dL on no prior lipid-lowering therapy?

Yes. High dose stain therapy’s pleiotropic effects after a ‘plaque rupture’ event cannot be overlooked. Also, LDL-C in plaque rupture events (ACS, STEMI, NSTEMI) can be transiently lower due to the acute-phase response/inflammation. Starting high-intensity therapy ensures the ≥50% drop and addresses...

This is an interesting question. Not a common scenario.

In setting of an acute MI, LDL numbers are not accurate and there is an acute decline.

High intensity statin therapy in setting of STEMI has proven to be beneficial in clinical trials. There has not been a study assessing these benefits in elder...

Yes, high-intensity statin therapy should be initiated immediately in all STEMI patients regardless of baseline LDL level, as guidelines recommend starting treatment before lipid results are available and continuing to achieve target reductions. Statins offer dual benefits in STEMI beyond LDL reduct...

High-intensity statin therapy is a cornerstone of therapy in acute coronary syndrome (ACS). Not sure I can make a cogent argument for low-intensity statin therapy after ST-elevation myocardial infarction (STEMI).