Abstract
AIMS: To evaluate whether a PDCA cycle-based early intensive lipid-lowering strategy could improve LDL-C goal attainment in patients with acute coronary syndrome undergoing PCI. METHODS: This retrospective, single-center cohort study enrolled 203 consecutive ACS patients undergoing PCI between January 2022 and January 2025. Patients were assigned to a control group receiving standard lipid-lowering therapy (n=101) or a PDCA intervention group (n=102) managed through a Plan-Do-Check-Act cycle-based early intensive lipid-lowering protocol. The primary endpoint was LDL-C goal attainment at 12 weeks (<1.8 mmol/L or ≥50% reduction). Secondary endpoints included lipid dynamics, medication adherence, therapy intensification, safety outcomes, and lifestyle adherence. Laboratory, echocardiographic, and behavioral data were prospectively collected and analyzed by blinded investigators using standardized protocols. RESULTS: The PDCA cycle-based strategy achieved greater and earlier reductions in LDL-C and total cholesterol, leading to higher LDL-C goal attainment (<1.8 mmol/L: 57.8% vs. 31.7%; ≥50% reduction: 61.7% vs. 28.7%; both P<0.001). High-intensity statin, ezetimibe, and PCSK9 inhibitor use were significantly higher, accompanied by improved medication adherence (94.38 ± 10.64% vs. 83.63 ± 11.56%, P<0.001) and lifestyle compliance. PDCA management enhanced LVEF improvement (from 53.84 ± 6.71 to 62.00 ± 6.09% vs. 52.91 ± 5.59 to 53.65 ± 6.09%; P<0.001) without increasing adverse events. Multivariate analysis confirmed PDCA intervention as an independent predictor of LDL-C goal achievement (OR 9.353, 95% CI 4.424-19.775; P<0.001). CONCLUSION: A PDCA cycle-based early intensive lipid-lowering strategy significantly improved LDL-C goal achievement, medication and lifestyle adherence, and cardiac function after PCI in ACS patients, without increasing adverse events.