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Erschienen in: Wiener klinische Wochenschrift 23-24/2023

24.10.2023 | original article

Low-density lipoprotein cholesterol reduction with immediate combination therapy of statin and ezetimibe compared to statin monotherapy after percutaneous coronary intervention

verfasst von: Achim Leo Burger, MD, Nora Beran, MD, Edita Pogran, MD, Christoph C. Kaufmann, MD, David Zweiker, MD, Marie Muthspiel, MD, Benjamin Panzer, MD, Bernhard Jäger, PhD, Miklos Rohla, PhD, Kurt Huber, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 23-24/2023

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Summary

Background

Current guidelines recommend a stepwise initiation of lipid-lowering therapy after percutaneous coronary interventions (PCI) in treatment-naïve individuals. Patients might benefit from an earlier and stronger low-density lipoprotein-cholesterol (LDL-C) reduction through upfront combination therapies.

Methods

This retrospective study included patients without previous lipid-lowering therapy undergoing acute or elective PCI with stent implantation between January 2016 and December 2019. Patients initiated on statin monotherapy vs. a combination of statin and ezetimibe were compared. The primary endpoint was an LDL‑C reduction into the target range of < 55 mg/dL at 3 months. The secondary endpoint was the occurrence of major cardiovascular events (MACE).

Results

A total of 204 lipid-lowering therapy naive patients were included, of whom 157 (77.0%) received statin monotherapy and 47 (23.0%) combination therapy. Median LDL‑C levels were higher in patients initiated on combination therapy vs. monotherapy (140 mg/dL, interquartile range, IQR, 123–167 mg/dL vs. 102 mg/dL, IQR 80–136 mg/dL, p < 0.001). The LDL‑C reduction was greater in patients treated with combination therapy vs. statin monotherapy (−73 mg/dL, −52.1% vs. −43 mg/dL, −42.2%, p < 0.001). While the primary endpoint was similar between groups (44.7% vs. 36.1%, p = 0.275), combination therapy significantly increased the proportion of patients achieving the treatment target in the presence of an admission LDL-C > 120 mg/dL (46.2% vs. 26.2%, p = 0.031). The rates of MACE were similar between the two groups (10.6% vs. 17.8%, p = 0.237) at a median follow-up of 2.2 years, IQR 1.46–3.10 years.

Conclusion

Immediate initiation of high-intensity statin and ezetimibe treatment might be considered as the default strategy in treatment-naïve patients with high admission LDL‑C undergoing PCI.
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Metadaten
Titel
Low-density lipoprotein cholesterol reduction with immediate combination therapy of statin and ezetimibe compared to statin monotherapy after percutaneous coronary intervention
verfasst von
Achim Leo Burger, MD
Nora Beran, MD
Edita Pogran, MD
Christoph C. Kaufmann, MD
David Zweiker, MD
Marie Muthspiel, MD
Benjamin Panzer, MD
Bernhard Jäger, PhD
Miklos Rohla, PhD
Kurt Huber, MD
Publikationsdatum
24.10.2023
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 23-24/2023
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-023-02296-z

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