A Hospital Lipid-lowering Protocol Improves 2-year Clinical Outcomes in Patients with Acute Coronary Syndrome

Overview

Journal AsiaIntervention

Date 2024 Sep 30

PMID 39347115

Authors

Sho Nakao

Takayuki Ishihara

Takuya Tsujimura

Osamu Iida

Yosuke Hata

Taku Toyoshima

Naoko Higashino

Masaya Kusuda

Toshiaki Mano

Affiliations

Soon will be listed here.

Abstract

Background: Although mortality after acute coronary syndrome (ACS) has improved in the acute phase, cardiovascular events occur at a certain frequency in the chronic phase. A hospital lipid-lowering protocol (HLP) could be effective in providing optimal lipid-lowering therapy to improve long-term clinical outcomes after ACS.

Aims: This study investigated the impact of HLP on clinical outcomes in patients with ACS.

Methods: We retrospectively analysed 1,114 ACS patients who had undergone successful percutaneous coronary intervention between November 2011 and June 2021. In December 2018, we introduced a HLP that included the prescription of the maximum tolerated dose of statin, ezetimibe, and eicosapentaenoic acid after ACS treatment. We compared 2-year clinical outcomes before (control group: 791 patients) and after the HLP's introduction (HLP group: 323 patients). The primary outcome was the non-target vessel revascularisation (non-TVR) rate. A multivariate Cox proportional hazard model and inverse probability weighting (IPW) based on the propensity score were used to evaluate the effect of HLP on the outcomes.

Results: The cumulative 2-year non-TVR incidence was significantly lower in the HLP group than in the control group (8.5% vs 13.8%; p=0.019). Multivariable analysis revealed non-TVR risk was significantly lower in the HLP group than in the control group (adjusted hazard ratio [aHR]: 0.637 [95% confidence interval [CI]: 0.416-0.975]; p=0.038). The IPW analysis confirmed a significant association between the HLP and a lower non-TVR risk (aHR: 0.544 [95% CI: 0.350-0.847]; p=0.007).

Conclusions: Implementing HLP for ACS patients improved the 2-year clinical outcome.

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