Author + information
- Thomas M. Maddoxa,b,
- Fengming Tanga,b,
- John Downsa,b,
- Frederick Masoudia,b,
- Salim Virania,b,
- Stacie Daughertya,b and
- John Rumsfelda,b
Background: The IMPROVE-IT trial demonstrated that ezetimibe plus simvastatin 40mg reduced cardiac events relative to simvastatin 40mg alone among acute coronary syndrome (ACS) patients. The applicability of these findings to current practice is unknown, particularly since recent guidelines recommend high-intensity statins, not moderate-intensity such as simvastatin 40mg, in all ACS patients.
Methods and Results: We studied ACS patients in the NCDR PINNACLE ambulatory cardiology registry between 2013-2014. We assessed the proportion meeting IMPROVE-IT inclusion criteria, their characteristics compared to the IMPROVE-IT population, and their current treatment patterns. Of 31,008 ACS patients, 10,960 (35.3%) met IMPROVE-IT inclusion criteria. Compared to the IMPROVE-IT population, PINNACLE patients meeting inclusion criteria were older, more likely female, had more cardiovascular comorbidities, and lower rates of statin, aspirin, ACEI/ARB, and beta-blocker use (Table).
Conclusions: Only one-third of current ACS patients would have qualified for the IMPROVE-IT trial. Compared to the trial population, they were older, sicker, and received less optimal secondary prevention therapies. Thus, it is unclear if the benefit seen with simvastatin/ezetimibe use in the trial translates to many current ACS patients. In addition, with current guidelines recommending high-intensity statins for all ACS patients, the impact of IMPROVE-IT on current practice is likely further reduced.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Lipid Management
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1203-314
- 2017 American College of Cardiology Foundation