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ACS Secondary Prevention — RACP Adult Medicine MCQ

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HardCardiologyACS Secondary PreventionRACP Adult Medicine

A 55-year-old is reviewed six weeks after NSTEMI and PCI. On maximally tolerated high-intensity statin therapy, LDL cholesterol has fallen from 3.6 to 1.6 mmol/L. Which interpretation best reflects the 2025 Australian ACS secondary-prevention target?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Add ezetimibe: the percentage reduction is sufficient, but the absolute LDL remains above 1.4 mmol/L

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

C is correct. The 2025 Australian ACS guideline uses both an LDL cholesterol below 1.4 mmol/L and at least a 50% reduction from baseline. This patient has achieved a 56% fall but remains above the absolute target, so adherence and secondary causes should be reviewed and additional lipid-lowering therapy considered. D reverses the findings: the proportional fall is already adequate. E ignores the unmet absolute threshold. A applies an older, less intensive absolute target and omits the dual requirement. B invents a more stringent universal target. Ezetimibe is generally the next addition to maximal statin, with a PCSK9-directed agent considered if the target remains unmet and access criteria are satisfied.

Reference: Heart Foundation and CSANZ: Australian acute coronary syndromes guideline 2025: https://www.heartfoundation.org.au/for-professionals/acs-guideline