This study investigated whether the small dense low-density lipoprotein cholesterol (sd-LDL-c) level is associated with the rapid progression (RP) of non-culprit coronary artery lesions and cardiovascular events (CE) after acute coronary syndrome (ACS).Methods: In 142 consecutive patients with ACS who underwent primary percutaneous coronary intervention for the culprit lesion, the sd-LDL-c level was measured using a direct homogeneous assay on admission for ACS and at the 10-month follow-up coronary angiography. RP was defined as a progression of any pre-existing coronary stenosis and/or stenosis development in the initially normal coronary artery. CEs were defined as cardiac death, myocardial infarction, stroke, or coronary revascularization.Results: Patients were divided into two groups based on the presence (n 29) or absence (n 113) of RP after 10 months. The LDL-c and sd-LDL-c levels at baseline were equivalent in both the groups. However, the sd-LDL-c, triglyceride, remnant lipoprotein cholesterol (RL-c), and apoC3 levels at follow-up were significantly higher in the RP group than in the non-RP group. The optimal threshold values of sd-LDL-c, triglyceride, RL-c, and apoC3 for predicting RP according to receiver operating characteristics analysis were 20.9, 113, 5.5, and 9.7 mg/dL, respectively. Only the sd-LDL-c level (≥ 20.9 mg/dL) was significantly associated with incident CEs at 31 17 months (log-rank: 4.123, p 0.043). Conclusions:The sd-LDL-c level on treatment was significantly associated with RP of non-culprit lesions, resulting in CEs in ACS patients. On-treatment sd-LDL-c is a residual risk and aggressive reduction of sd-LDL-c might be needed to prevent CEs. medications, are recommended for reducing the subsequent risk of major cardiovascular events (CEs) in patients with ACS 1) . The suggested target LDL-c level is less than 70 mg/dL for the secondary prevention in ACS 2) . However, some patients present with CEs even after achieving an LDL-c level belowCopyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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Highlights Even small declines in renal function are associated with worse short-term outcomes after AMI. The clinical impact of the timing of acute kidney injury (AKI) onset after AMI is unknown. Early-phase AKI is associated with poor long-term mortality. Late-phase AKI is not associated with poor long-term mortality. Careful clinical attention and intensive care should be used in patients with early-phase AKI after AMI.