所属 医学部 医学科（東京女子医科大学病院） 職種 准教授
|発表タイトル||Differences in the Usefulness of Aggressive Lipidlowering Therapy among Single-vessel and Multivessel Coronary Artery Disease Patients: HIJPROPER Sub-study|
|会議名||The 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS2019)|
|主催者||Japanese Circulation Society|
|発表者・共同発表者||◎OGISO Masataka, YAMAGUCHI Junichi, WATANABE Erisa, SEKIGUCHI Haruki, OGAWA Hiroshi, HAGIWARA Nobuhisa|
|概要||*Oral Presentation (English)33 ACS/AMI
Background: Acute coronary syndrome (ACS) patients with multi-vessel coronary artery disease (MVD) are at high risk of recurrent cardiovascular events. The purpose of the present study was to examine the efficacy of aggressive lipid-lowering therapy in patients with MVD and singlevessel disease (SVD). Methods: The study population was derived from the HIJ-PROPER study, in which, ACS patients with dyslipidemia were randomized to pitavastatin + ezetimibe therapy (targeting LDL-C less than 70mg/dl) or pitavastatin-monotherapy (targeting LDL-C less than 90mg/dl) and treatment efficacy was compared between patients with MVD and SVD. The primary end point was a composite of major advanced cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia driven revascularization. Results: We identified 1702 eligible patients (mean age, 65.6 years; male, 75.6%); 870 patients (51.1%) had MVD and 832 (48.9%) patients had SVD. The incidence of MACEs was significantly higher in MVD group compared to SVD group (43.7% vs 25.9%, hazard ratio 1.95, 95% confidence interval 1.65-2.31, p<0.001). In MVD group, the Kaplan-Meier analysis showed no significant difference in MACEs between pitavastatin + ezetimibe therapy and pitavastatin-monotherapy group. (43.5% vs. 43.9%, 1.0, 0.82-1.23, p=0.95). However, in SVD group, pitavastatin + ezetimibe therapy showed significantly fewer MACEs than pitavastatin-monotherapy (34.6% vs. 47.4%, 0.72, 0.55-0.94, p=0.017). Conclusions: The aggressive lipid-lowering treatment with ezetimibe showed favorable impact on clinical outcomes in SVD patients but not in MVD patients, suggesting different treatment approach might be necessary in ACS patients with MVD.