Impact of an Intensive Lipid-Lowering Therapy Protocol on Achieving Target Low-Density Lipoprotein Cholesterol Levels in Patients With Acute Coronary Syndrome

被引:1
作者
Seiyama, Kosuke [1 ]
Oka, Akihiro [1 ]
Miyoshi, Toru [2 ]
Sudo, Yuya [1 ]
Takagi, Wataru [1 ]
Ugawa, Satoko [1 ]
Okada, Tomoaki [1 ]
Nosaka, Kazumasa [1 ]
Doi, Masayuki [1 ]
机构
[1] Kagawa Prefectural Cent Hosp, Dept Cardiol, 1-2-1 Asahi Machi, Takamatsu, Kagawa 7608557, Japan
[2] Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Cardiovasc Med, Okayama, Japan
关键词
Acute coronary syndrome; Cardiovascular events; Ezetimibe; Lipid-lowering therapy; Statin; CLINICAL-OUTCOMES; STATIN THERAPY; EZETIMIBE; ATORVASTATIN;
D O I
10.1253/circrep.CR-24-0071
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Intensive lipid-lowering therapy (ILLT) is crucial for preventing secondary acute coronary syndrome (ACS). However, achieving target low-density lipoprotein cholesterol (LDL-C) levels remains challenging in clinical practice. Methods and Results: This retrospective study included 534 patients with ACS who underwent primary percutaneous coronary intervention (PCI) between September 2016 and August 2022. The ILLT protocol, wherein ezetimibe and statins are prescribed, was introduced in September 2019. We compared the rate of achievement of the LDL-C target of <70 mg/dL at the first outpatient visit and the incidence of cardiovascular events during the 3-year observation period after PCI between the conventional therapy (n=226) and ILLT (n=308) groups. The ILLT group had a higher achievement rate than the conventional therapy group (71.8% vs. 48.7%; P=0.001). In the ILLT group, 17% of statin-na & iuml;ve patients did not achieve the LDL-C target, and the cutoff value of LDL-C on admission for predicting non-achievement of this target was 146 mg/dL. Patients in the ILLT group showed a significantly lower incidence of cardiovascular events than those in the conventional therapy group (hazard ratio 0.57; 95% confidence interval 0.34-0.97). Conclusions: Implementing the ILLT protocol using statins and ezetimibe helped achieve the target LDL-C level early in patients with ACS and may consequently improve prognosis. However, patients with LDL-C levels >= 146 mg/dL on admission may need more intensive treatment.
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收藏
页码:131 / 138
页数:8
相关论文
共 23 条
[1]   2023 ESC Guidelines for the management of acute coronary syndromes [J].
Byrne, Robert A. ;
Rossello, Xavier ;
Coughlan, J. J. ;
Barbato, Emanuele ;
Berry, Colin ;
Chieffo, Alaide ;
Claeys, Marc J. ;
Dan, Gheorghe-Andrei ;
Dweck, Marc R. ;
Galbraith, Mary ;
Gilard, Martine ;
Hinterbuchner, Lynne ;
Jankowska, Ewa A. ;
Juni, Peter ;
Kimura, Takeshi ;
Kunadian, Vijay ;
Leosdottir, Margret ;
Lorusso, Roberto ;
Pedretti, Roberto F. E. ;
Rigopoulos, Angelos G. ;
Gimenez, Maria Rubini ;
Thiele, Holger ;
Vranckx, Pascal ;
Wassmann, Sven ;
Wenger, Nanette Kass ;
Ibanez, Borja ;
ESC Sci Document Grp .
EUROPEAN HEART JOURNAL, 2023, 44 (38) :3720-3826
[2]   Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes [J].
Cannon, Christopher P. ;
Blazing, Michael A. ;
Giugliano, Robert P. ;
McCagg, Amy ;
White, Jennifer A. ;
Theroux, Pierre ;
Darius, Harald ;
Lewis, Basil S. ;
Ophuis, Ton Oude ;
Jukema, J. Wouter ;
De Ferrari, Gaetano M. ;
Ruzyllo, Witold ;
De Lucca, Paul ;
Im, KyungAh ;
Bohula, Erin A. ;
Reist, Craig ;
Wiviott, Stephen D. ;
Tershakovec, Andrew M. ;
Musliner, Thomas A. ;
Braunwald, Eugene ;
Califf, Robert M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (25) :2387-2397
[3]   Intensive versus moderate lipid lowering with statins after acute coronary syndromes [J].
Cannon, CP ;
Braunwald, E ;
McCabe, CH ;
Rader, DJ ;
Rouleau, JL ;
Belder, R ;
Joyal, SV ;
Hill, KA ;
Pfeffer, MA ;
Skene, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (15) :1495-1504
[4]   Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study) [J].
Fox, Keith A. A. ;
Carruthers, Kathryn F. ;
Dunbar, Donald R. ;
Graham, Catriona ;
Manning, Jonathan R. ;
De Raedt, Herbert ;
Buysschaert, Ian ;
Lambrechts, Diether ;
Van de Werf, Frans .
EUROPEAN HEART JOURNAL, 2010, 31 (22) :2755-2764
[5]   Acute Coronary Syndromes Pathology, Diagnosis, Genetics, Prevention, and Treatment [J].
Fuster, Valentin ;
Kovacic, Jason C. .
CIRCULATION RESEARCH, 2014, 114 (12) :1847-1851
[6]   JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome [J].
Kimura, Kazuo ;
Kimura, Takeshi ;
Ishihara, Masaharu ;
Nakagawa, Yoshihisa ;
Nakao, Koichi ;
Miyauchi, Katsumi ;
Sakamoto, Tomohiro ;
Tsujita, Kenichi ;
Hagiwara, Nobuhisa ;
Miyazaki, Shunichi ;
Ako, Junya ;
Arai, Hirokuni ;
Ishii, Hideki ;
Origuchi, Hideki ;
Shimizu, Wataru ;
Takemura, Hirofumi ;
Tahara, Yoshio ;
Morino, Yoshihiro ;
Iino, Kenji ;
Itoh, Tomonori ;
Iwanaga, Yoshitaka ;
Uchida, Keiji ;
Endo, Hirohisa ;
Kongoji, Ken ;
Sakamoto, Kenji ;
Shiomi, Hiroki ;
Shimohama, Takao ;
Suzuki, Atsushi ;
Takahashi, Jun ;
Takeuchi, Ichiro ;
Tanaka, Akihito ;
Tamura, Toshihiro ;
Nakashima, Takahiro ;
Noguchi, Teruo ;
Fukamachi, Daisuke ;
Mizuno, Tomohiro ;
Yamaguchi, Junichi ;
Yodogawa, Kenji ;
Kosuge, Masami ;
Kohsaka, Shun ;
Yoshino, Hideaki ;
Yasuda, Satoshi ;
Shimokawa, Hiroaki ;
Hirayama, Atsushi ;
Akasaka, Takashi ;
Haze, Kazuo ;
Ogawa, Hisao ;
Tsutsui, Hiroyuki ;
Yamazaki, Tsutomu .
CIRCULATION JOURNAL, 2019, 83 (05) :1085-1196
[7]   Evolocumab for Early Reduction of LDL Cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS) [J].
Koskinas, Konstantinos C. ;
Windecker, Stephan ;
Pedrazzini, Giovanni ;
Mueller, Christian ;
Cook, Stephane ;
Matter, Christian M. ;
Mueller, Olivier ;
Haner, Jonas ;
Gencer, Baris ;
Crljenica, Carmela ;
Amini, Poorya ;
Deckarm, Olga ;
Iglesias, Juan F. ;
Raber, Lorenz ;
Heg, Dik ;
Mach, Francois .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2019, 74 (20) :2452-2462
[8]   Impact of Implementation of a Region-Wide Low-Density Lipoprotein Cholesterol Management Clinical Pathway for the Secondary Prevention of Acute Myocardial Infarction [J].
Kurobe, Masaya ;
Baba, Kensho ;
Nunohiro, Tatsuya ;
Ishizaki, Masahiko ;
Furudono, Shinnosuke ;
Nakata, Tomoo ;
Koide, Yuji ;
Hazama, Minoru ;
Sakai, Katsuaki ;
Muto, Shinsuke ;
Yamaguchi, Tatsuyuki ;
Fujii, Takashi ;
Yarimizu, Daisuke ;
Toda, Mitsutoshi ;
Iekushi, Kazuma ;
Ikeda, Satoshi ;
Maemura, Koji .
CIRCULATION JOURNAL, 2024, 88 (11) :1825-1832
[9]   Safety and efficacy of statins in Asians [J].
Liao, James K. .
AMERICAN JOURNAL OF CARDIOLOGY, 2007, 99 (03) :410-414
[10]   Effects of routine early treatment with PCSK9 inhibitors in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a randomised, double-blind, sham-controlled trial [J].
Mehta, Shamir R. ;
Pare, Guillaume ;
Lonn, Eva M. ;
Jolly, Sanjit S. ;
Natarajan, Madhu K. ;
Pinilla-Echeverri, Natalia ;
Schwalm, Jon-David ;
Sheth, Tej N. ;
Sibbald, Matthew ;
Tsang, Michael ;
Valettas, Nicholas ;
Velianou, James L. ;
Lee, Shun Fu ;
Ferdous, Tahsin ;
Nauman, Sadia ;
Nguyen, Helen ;
McCready, Tara ;
McQueen, Matthew J. .
EUROINTERVENTION, 2022, 18 (11) :888-+