Mi Seon Ji1, Myung Ho Jeong2, Young Keun Ahn1, Sang Hyung Kim1, Young Jo Kim3, Shung Chull Chae4, Taek Jong Hong5, In Whan Seong6, Jei Keon Chae7, Chong Jin Kim8, Myeong Chan Cho9, Seung-Woon Rha10, Jang Ho Bae11, Ki Bae Seung12, Seung Jung Park13. 1. Chonnam National University Hospital, Gwangju, Republic of Korea. 2. Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 3. Yeungnam Univ. Hosp., Daegu, Republic of Korea. 4. Kyungpuk National Univ. Hosp., Daegu, Republic of Korea. 5. Busan National Univ. Hosp., Busan, Republic of Korea. 6. Chungnam National Univ. Hosp., Daejon, Republic of Korea. 7. Chunbuk National Univ. Hosp., Jeonju, Republic of Korea. 8. KyungHee Univ. Hosp., Seoul, Republic of Korea. 9. Chungbuk National University Hospital, Cheongju, Republic of Korea. 10. Korea University Guro Hospital, Seoul, Republic of Korea. 11. Konyang University, Daejon, Republic of Korea. 12. Catholic Univ. Hosp., Seoul, Republic of Korea. 13. Asan Medical Center, Seoul, Republic of Korea.
Abstract
BACKGROUND: It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. METHODS: A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. RESULTS: In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. CONCLUSIONS: In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients.
BACKGROUND: It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. METHODS: A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. RESULTS: In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. CONCLUSIONS: In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients.