Lipid-Lowering Treatment Gaps in Patients after Acute Myocardial Infarction: Using Global Database TriNetX
Grete Talviste1, Mall Leinsalu2, Peeter Ross1
1Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Ehitajate Street 5, 19086 Tallinn, Estonia.
Insights
Patients with acute myocardial infarction (AMI) have high recurrent event risk. Lipid-lowering therapy gaps persist post-AMI, leaving many patients with high LDL-C and cardiovascular risk.
Area of Science:
- Cardiology
- Clinical Research
- Health Informatics
Background:
- Patients with previous acute myocardial infarction (AMI) face elevated risks of recurrent cardiovascular events.
- Effective lipid-lowering therapy, particularly targeting low-density lipoprotein cholesterol (LDL-C), is crucial for managing cardiovascular risk in post-AMI patients.
- Real-world data is essential to identify and address treatment gaps in post-AMI care.
Purpose of the Study:
- To assess real-life lipid-lowering treatment gaps in patients following acute myocardial infarction (AMI).
- To evaluate the feasibility of using the TriNetX global data network for clinical research in this patient population.
- To identify the extent to which LDL-C goals are met in post-AMI patients.
Main Methods:
- Retrospective analysis of global patient data from the TriNetX platform in 2020.
- Inclusion of patients diagnosed with acute myocardial infarction (AMI) and a three-year follow-up period.
- Evaluation of lipid-lowering medication prescribing rates and achieved LDL-C levels.
Main Results:
- Lipid-lowering medication prescribing rates were insufficient to achieve target LDL-C levels post-AMI.
- Mean LDL-C levels decreased post-AMI but remained elevated, with only 7-12% achieving <55 mg/dL and 13-20% <70 mg/dL.
- A substantial number of patients remained at high risk for cardiovascular complications and mortality due to suboptimal LDL-C control.
Conclusions:
- Significant gaps exist between guideline recommendations for LDL-C management and real-world clinical practice in post-AMI patients.
- The TriNetX platform demonstrates potential as an innovative tool for clinical research, enabling access to interinstitutional data.
- Further development and utilization of platforms like TriNetX are recommended for improving post-AMI care and research.
Abstract:
Background and Objectives: Patients with previous acute myocardial infarction are at significantly higher risk of recurrent events. Early and intensive lipid-lowering therapy targeting low-density lipoprotein cholesterol is a key strategy for reducing cardiovascular risk in post-acute myocardial infarction patients worldwide. This study aimed to assess patients' real-life lipid-lowering treatment gaps after acute myocardial infarction using a global network, TriNetX, of anonymous, real-time patient data. The uniqueness of the study was the use of the novel, evolving, and constantly improving TriNetX platform and the evaluation of its feasibility for clinical research. Materials and Methods: A retrospective study was conducted on global repository patients in 2020, diagnosed with acute myocardial infarction, with a three-year follow-up. Results: After acute myocardial infarction, the prescribing rate of lipid-lowering medication (statins, ezetimibe and PCSK9I) was insufficient to reach target LDL-C values. The mean LDL-C level decreased from 2.7 mmol/L (103 mg/dL) as measured on the day of AMI to 1.97 mmol/L (76 mg/dL) between 31D and 3M. During the second and third years, the mean LDL-C value was stable (around 2.0 mmol/L (78 mg/dL)). LDL-C goals were not sufficiently reached, as only 7-12% of patients were reported to have LDL-C values < 55 mg/dL (1.4 mmol/L) and 13-20% of patients were reported to have LDL-C values < 70 mg/dL (1.8 mmol/L) during the follow-up periods. This means that a substantial number of patients remain at a very high risk for CV complications and mortality. Most cardiovascular complications happen within three months after acute myocardial infarction. Conclusions: Gaps remain between the recommendations for managing LDL-C in guidelines and what occurs in real life. The TriNetX platform is an innovative platform with significant potential and should be further developed for clinical research, as it enables the use of valuable interinstitutional data.
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