Publication details
Improve IT změní guidelines
| Title in English | Improve IT will change guidelines |
|---|---|
| Authors | |
| Year of publication | 2014 |
| Type | Article in Periodical |
| Magazine / Source | Kardiologická revue - Interní medicína |
| MU Faculty or unit | |
| Citation | |
| Field | Cardiovascular diseases incl. cardiosurgery |
| Keywords | simvastatin; ezetimibe; cholesterol; acute coronary syndrome |
| Description | Background:The IMProved Reduction of Outcomes: Vytorin Efficacy Inter-national Trial (IMPROVE-IT) study is evaluating the potential benefit for reduction in major cardiovascular (CV) events of the addition of ezetimibe versus placebo to 40 mg/d of simvastatin therapy in patients who present with acute coronary syndromes and have low-density lipoprotein cholesterol (LDL-C) < 1 25 mg/dL Methods: The primary composite end point was CV death, nonfatal myocardial infarction (Ml), nonfatal stroke, re-hospitalization for unstable angina (UA), and coronary revascularization (> 30 days postran-domizationJ.The simvastatin mo-notherapy arm's LDL-C target was < 70 mg/dL. Ezetimibe was assumed to further lower LDL-C by 1 5 mg/dL and produce an estimated -8% to 9% treatment effect. The targeted number of events was 5,250. Results: 1 8,1 44 patients were enrolled with either ST-segment elevation Ml (STEMI, n = 5,1 92) or UA/non-ST-seg-ment elevation Ml (UA/NSTEMI, n = 12,952) from October 2005 to July 2010. Western Europe (40%) and North America (38%) were the leading enrolling regions. The STEMI cohort was younger and had a higher percentage of patients naive to lipid-lowering treatment compared to the UA/NSTEM! cohort.The UA/NSTEMI group had a higher prevalence of diabetes, hypertension, and prior Ml. Median LDL-C at entry was 1 00 mg/dL for STEMI and 93 mg/dL for UA/NSTEMI patients. Primary endpoint occurred in 2,742 patients (34.7%) treated with simvastatin in monotherapy and in 2,572 patients (32.7%) (p = 0,016) treated with combination treatment. To avoid one primary outcome, treatment of 50 patients for seven years was necessary. The study has shown a clear benefit from combination treatment with simvas-tatin and ezetimibe in patients with acute coronary syndrome and low LDL-C. |