Early Triple Lipid-Lowering Therapy With Bempedoic Acid After Acute Coronary Syndrome

This randomized clinical trial will evaluate whether starting bempedoic acid in addition to high-intensity statin therapy and ezetimibe within 72 hours after percutaneous coronary intervention improves low-density lipoprotein cholesterol (LDL-C) control in adults with acute coronary syndrome. Participants will receive either triple therapy with a high-intensity statin, ezetimibe, and bempedoic acid or standard dual therapy with a high-intensity statin and ezetimibe for 12 weeks. The primary outcome is the proportion of participants with LDL-C below 55 mg/dL at Week 12. Changes in lipid and inflammatory markers, medication adherence, and treatment-emergent adverse events will also be assessed.

Inclusion Criteria: * Age 18 years or older. * Confirmed acute coronary syndrome, including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, or unstable angina. * Percutaneous coronary intervention within the preceding 72 hours. * Baseline LDL-C of at least 70 mg/dL. * Able and willing to provide written informed consent. Exclusion Criteria: * Current use of a PCSK9 inhibitor or fibrate at baseline. * History of symptomatic hyperuricemia or gout. * Severe hepatic impairment, defined as ALT or AST greater than 3 times the upper limit of normal at screening. * Known gallbladder disease, including cholelithiasis or previous cholecystitis. * Known intolerance or contraindication to statins, ezetimibe, or bempedoic acid. * Triglycerides of at least 400 mg/dL at screening. * Estimated glomerular filtration rate below 30 mL/min/1.73 m2 or dialysis. * Active systemic infection or acute inflammatory disease that could interfere with hs-CRP interpretation. * Current participation in another interventional clinical trial. * Pregnancy, breastfeeding, or planned pregnancy during the study period.