1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2Charité - Universitätsmedizin Berlin CC 11: Med. Klinik für Kardiologie Berlin, Deutschland; 3Herz- und Gefäßpraxis Gera, Internistisch-kardiologische Gemeinschaftspraxis Gera, Deutschland
Background
Jena auf Ziel – JaZ” is a prospective cohort study in which early combination therapy with atorvastatin 80 mg and ezetimibe 10 mg was initiated on admission in patients with ST – elevation myocardial infarction (STEMI) and lipid – lowering therapy (LLT) was escalated during follow – up with bempedoic acid (BA) and PCSK9 – inhibitors (PCSK9 – I). During follow – up 12 months after the index event in our outpatient lipid clinic LDL – C targets were attained in all patients.
Methods
After 12 months patients could decide to continue either with regular follow – ups in the outpatient lipid clinic or get routine standard care by general physicians (GP). 53 patients (65.4%) continued to visit the outpatient lipid clinic and 32 (33.6%) preferred standard care treatment. After 24 months differences between these two patient cohorts in regard to changes in lipid – lowering medications, LDL – C target attainment, LDL – C time on target during follow – up and major adverse cardiac events (MACE = nonfatal ischemic cardiovascular events, admission for heart failure, nonfatal stroke) were analyzed.
Results
A total of 85 consecutive patients were included in this study. 73 (85.9%) were male, 12 (14.1%) were female, the average age was 64.4 ± 13.1 years. All 85 patients were followed – up for 24 months. During the follow – up, 4 patients died due to non – cardiac causes. LLT after 24 months: 78 (96%) patients were on statins (atorvastatin / rosuvastatin), 71 (87.7%) patients were on ezetimibe, 14 (17.3%) patients were on BA, and 5 (6.2%) patients were on PCSK9 – I. The average LDL – C after 24 months was 1.38 ± 0.69 mmol/L in the total study population (Figure). 51 patients (63%) of the entire cohort were still on LDL – C target of 1.4 mmol/L or below (outpatient lipid clinic group: 72.5% vs. GP group: 27.5%; p 0.037). The average LDL – C in patients followed – up in the outpatient lipid clinic was significantly lower compared to patients who were treated by their GPs (1.3 ± 0.7 mmol/L vs. 2.33 ± 1.04 mmol/L; p < 0.01; Figure). Moreover, patients in the outpatient lipid clinic had a longer time on LDL – C targets compared to patients treated by GPs (82.4 ± 29.5% vs. 62.4 ± 36.6%; p < 0.01). The main cause of missed LDL – C targets was alterations of LLT by local GPs, surpassing non – adherence (2.33 ± 1.04 mmol/L vs. LDL – C: 1.52 ± 0.53 mmol/L; p < 0.01) in the overall study population (Figure). Patients with MACE during follow – up were characterized by a shorter time on LDL – C targets compared to patients without MACE (58.1 ± 29.9% vs. 79.1 ± 28.1%; p = 0.048) and higher LDL – C levels at 24 months (2.04 ± 1.26 mmol/L vs. 1.27 ± 0.47 mmol/L; p < 0.01). Altogether, male patients with three – vessel coronary artery disease and with reduced ejection fraction were more affected by MACE.
Conclusion: Follow – up in specialized outpatient lipid clinics optimizes lipid – lowering therapies and improves LDL – C target attainment compared to standard care by general physicians.