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Intensified lipid lowering using ezetimibe after publication of the IMPROVE-IT trial: A contemporary analysis from the SPUM-ACS cohort.

Cardiology Division, Geneva University Hospitals, Switzerland; TIMI Study Group, Brigham and Women's Hospitals, Harvard Medical School, Boston, USA. Electronic address: baris.gencer@hcuge.ch. Cardiology Division, Geneva University Hospitals, Switzerland. Department of Ambulatory Care and Community Medicine, Lausanne University, Switzerland. Department of Cardiology, University Hospital of Bern, Switzerland. Department of Cardiology, University Heart Center, University of Zurich, Switzerland. Institute of Primary Health Care (BIHAM), University of Bern, Switzerland. Department of Internal Medicine, Geneva University Hospitals, Switzerland. Institute of Social and Preventive Medicine, and Clinical Trials Unit, Department of Clinical Research, University of Bern, Switzerland. Center for Molecular Cardiology, University of Zurich, Switzerland; Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, United Kingdom. Department of Cardiology, University Heart Center, University of Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland. Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.

International journal of cardiology. 2020;:8-13
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Abstract

BACKGROUND The relevance of the IMPROVE-IT trial on real-life practice has not been explored in patients with ACS. METHODS A prospective Swiss cohort of 6266 patients hospitalized for ACS between 2009 and 2017 with a one-year follow-up. The primary endpoints were the ezetimibe use overall or in combination with high-intensity statin at discharge and at one year after ACS. Secondary endpoint was LDL-C target achievement at one year in a subsample of 2984 patients. Relative Ratios (RR) were used to assess changes in primary endpoints before and after the publication of IMPROVE-IT, adjusting for age, sex, diabetes, prior myocardial infarction, LDL-C and attendance to cardiac rehabilitation. RESULTS The period following the publication of the IMPROVE-IT trial was associated with a steady increase in the use of ezetimibe at discharge (from 1.8% to 3.8%, P < 0.001, adjusted RR 2.85, 95% CI 1.90-4.25) and at one year (from 5.0% to 13.8%, P < 0.001, adjusted RR 3.00, 95% CI 2.40-3.75). The combination of high-intensity statin and ezetimibe rose from 0.9% to 2.1% at discharge (P < 0.001, adjusted RR 3.35, 95% CI 1.90-5.89) and from 2.1% to 7.8% at one year (P < 0.001, adjusted RR 3.98, 95% CI 2.90-5.47). The period following the publication of the IMPROVE-IT trial was associated with an improvement of LDL-C target <1.8 mmol/L (adjusted RR 1.37, 95% CI 1.12-1.68). CONCLUSIONS After the publication of the IMPROVE-IT trial, the use of ezetimibe was increased by three-fold in a large contemporary cohort of ACS patients, concomitant with an improved LDL-C target achievement.

Methodological quality

Publication Type : Clinical Trial ; Multicenter Study

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