HIROSHI OGAWA
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Associate Professor
Language English
Title Differences in the Usefulness of Aggressive Lipidlowering Therapy among Single-vessel and Multivessel Coronary Artery Disease Patients: HIJPROPER Sub-study
Conference The 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS2019)
Promoters Japanese Circulation Society
Conference Type Nationwide Conferences
Presentation Type Speech
Lecture Type General
Publisher and common publisher◎OGISO Masataka, YAMAGUCHI Junichi, WATANABE Erisa, SEKIGUCHI Haruki, OGAWA Hiroshi, HAGIWARA Nobuhisa
Date 2019/03/31
Venue
(city and name of the country)
Yokohama, JAPAN
Summary *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.