| Autor: |
Casula, Matteo, Taietti, Ivan, Galazzi, Marco, Zeqaj, Iris, Fortuni, Federico, Cornara, Stefano, Somaschini, Alberto, Leonardi, Sergio, Camporotondo, Rita, Totaro, Rossana, Ferlini, Marco, Gnecchi, Massimiliano |
| Zdroj: |
Circulation (Ovid); November 2021, Vol. 144 Issue: Supplement 1 pA13767-A13767, 1p |
| Abstrakt: |
Introduction:There is no agreement among international guidelines (GL) on the recommended therapeutic target for LDL cholesterol in secondary prevention (SP).Hypothesis:The aim of this study was to determine the risk of major adverse cardiovascular events (MACE) during follow-up in a real-world SP population according to the achievement of a purely numerical threshold (i.e. LDL<1.8mmol/L [Canadian 2021 GL], group A) or a target that also considers a relative reduction in LDL levels (i.e. LDL reduced ≥50% from baseline and <1.8mmol/L [AHA/ACC 2018 GL] or <1.4 mmol/L [ESC 2019 GL], group B).Methods:We conducted a retrospective analysis of a monocentric observational registry prospectively enrolling patients admitted for STEMI between 2011 and 2019. The combined endpoint of MACE included all-cause death, non-fatal MI, non-fatal stroke, and unplanned revascularization. The lowest LDL value collected between 1 and 12 months after the index event was used to define the achievement of the target. We conducted a Kaplan-Meier analysis comparing patients who achieved different GL-recommended targets.Results:A total of 1199 patients (23% female) were included. Median age was 63 (54-72) years, 56% had hypertension, 17% diabetes, and 38% were smoker. Baseline LDL was 3.2 (2.5-3.8) mmol/L; 83% of patients were treated with statin therapy alone, and 17% with the addition of ezetimibe. Median follow-up was 53 (32-70) months. The Canadian, AHA/ACC and ESC targets were achieved in 842 (70%), 506 (42%) and 308 (26%) patients respectively; MACE-free analysis based on the target achieved is presented in FigA. The net incidence of MACE was 29% in group A vs 15% in group B (HR 1.97; 95%CI 1.36-2.85; P log-rank=0.0003; NNT=7; FigB).Conclusions:Our data from a real-world cohort of secondary prevention patients emphasize the importance of achieving a guideline-recommended target that also considers a relative reduction in LDL levels (i.e. LDL ≤50% from baseline) in order to reduce MACE. |
| Databáze: |
Supplemental Index |
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