A hospital lipid-lowering protocol improves 2-year clinical outcomes in patients with acute coronary syndrome.

AsiaIntervention Pub Date : 2024-09-27 eCollection Date: 2024-09-01 DOI:10.4244/AIJ-D-23-00056

Sho Nakao, Takayuki Ishihara, Takuya Tsujimura, Osamu Iida, Yosuke Hata, Taku Toyoshima, Naoko Higashino, Masaya Kusuda, Toshiaki Mano

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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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医院降脂方案可改善急性冠状动脉综合征患者的 2 年临床疗效。

背景：虽然急性冠状动脉综合征（ACS）后的死亡率在急性期有所改善，但心血管事件在慢性期仍会频繁发生。医院降脂方案（HLP）可有效提供最佳降脂治疗，从而改善急性冠状动脉综合征后的长期临床预后。目的：本研究探讨了医院降脂方案对急性冠状动脉综合征患者临床预后的影响：我们回顾性分析了2011年11月至2021年6月期间成功接受经皮冠状动脉介入治疗的1114例ACS患者。2018年12月，我们引入了HLP，其中包括在ACS治疗后处方最大耐受剂量的他汀类药物、依折麦布和二十碳五烯酸。我们比较了引入 HLP 前（对照组：791 名患者）和引入 HLP 后（HLP 组：323 名患者）的两年临床结果。主要结果是非目标血管再通率（non-target vessel revascularisation，NTVR）。采用多变量考克斯比例危险模型和基于倾向评分的逆概率加权（IPW）来评估HLP对结果的影响：结果：HLP组的2年累积非TVR发生率明显低于对照组（8.5% vs 13.8%；P=0.019）。多变量分析显示，HLP 组的非 TVR 风险明显低于对照组（调整后危险比 [aHR]：0.637 [95% 置信区间 [CI]：0.416-0.975]; p=0.038).IPW分析证实，HLP与非TVR风险降低之间存在显著关联（aHR：0.544 [95% CI：0.350-0.847]；p=0.007）：结论：对ACS患者实施HLP可改善2年的临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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AsiaIntervention

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0.90

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