The Association Between Time of Lipid-Lowering Therapy Initiation and Acute Clinical Presentation Among Patients
David Eccleston1, Enayet K Chowdhury2, Alex Wang3
1Advara HeartCare, Brisbane, Qld, Australia; University of Melbourne, Parkville, Vic, Australia.
Insights
Initiating lipid-lowering therapy (LLT) before percutaneous coronary intervention (PCI) reduces acute coronary syndrome (ACS) risk. Long-term outcomes were similar for early vs. later LLT initiation in ACS patients undergoing PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Lipid-lowering therapy (LLT) is crucial for managing coronary artery disease (CAD).
- The impact of LLT initiation timing on patient outcomes remains unclear.
Purpose of the Study:
- To investigate the association between the timing of LLT initiation (pre- vs. post-PCI admission) and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A registry-based study of 5,433 patients undergoing PCI.
- Comparison of outcomes based on LLT initiation before (PRE-LLT) or after (POST-LLT) hospital admission.
- Analysis of acute coronary syndrome (ACS) prevalence and short- and long-term clinical events post-PCI.
Main Results:
- Patients initiating LLT before PCI (PRE-LLT) had a lower prevalence of ACS prior to admission compared to those initiating LLT after admission (POST-LLT) (32.3% vs. 56.9%).
- PRE-LLT patients were older and had more comorbidities (diabetes, hypertension, renal failure).
- No significant difference in short- or long-term cardiovascular or overall clinical events was observed between PRE-LLT and POST-LLT groups post-PCI.
Conclusions:
- Early initiation of LLT before revascularization is associated with a reduced risk of ACS in patients with CAD.
- Long-term outcomes following PCI for ACS may not differ significantly between high-risk patients receiving early LLT and lower-risk patients starting LLT later.
Background:
Lipid-lowering therapy (LLT) is established as a key element in management of patients with coronary artery disease. However, the effect of time of initiation of LLT on outcomes is unclear.
Method:
The study compared outcomes of 5,433 patients from Advara HeartCare's Percutaneous Coronary Intervention (PCI) Registry on the basis of timing of LLT initiation classified as pre- or post-PCI admission. The prevalence of acute coronary syndrome (ACS) as the indication for PCI was compared in groups. In patients who underwent PCI for ACS, the incidence of short- (≤30 days) and long-term (>30 days after admission) clinical events (composite of myocardial infarction, cerebrovascular disease, coronary revascularisation, all-cause readmission, and mortality) and first non-fatal cardiovascular events were compared in groups.
Results:
At the time of hospitalisation for PCI, 3,982 (73.7%) were on LLT (PRE-LLT), and 1,418 (26.2%) initiated LLT after admission (POST-LLT). Patients on PRE-LLT were significantly less likely to experience ACS before admission for PCI than were those commencing LLT after discharge (PRE-LLT 32.3% vs POST-LLT 56.9%; p<0.001), even after matching for baseline risk factors. Among these patients with ACS, patients on PRE-LLT were older than those on POST-LLT (mean 69.5±9.5 vs 65.0±10.0 years; p<0.001), and had a higher prevalence of cardiovascular risk factors including diabetes (31.5% vs 9.6%; p<0.001), hypertension (79.7% vs 51.7%; p<0.001), and renal failure (7.6% vs 2.0%; p<0.001). No difference was observed between groups in the risk of short- or long-term (median 2.0 years; interquartile range 1.0-3.0) post-PCI cardiovascular (hazard ratio [HR] 1.08; 0.83-1.40; p=0.55) or overall clinical events (HR 1.11; 0.93-1.32; p=0.26).
Conclusions:
In patients with coronary artery disease, the risk of ACS is reduced by early initiation of LLT before revascularisation is required. Long-term outcomes of patients at high risk prescribed LLT before admission for ACS PCI may not differ from those of patients at lower risk commencing LLT after PCI for ACS.
More Related Videos
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
01:14Time Course of Drug Effect
01:38Inflammation
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:15Drug Concentration Versus Time Correlation
Two pivotal parameters are the minimum effective concentration (MEC) and the minimum toxic concentration (MTC). The MEC is the...