Abstract 17544: Utilization of Intensive Lipid-Lowering Therapy After an Acute Coronary Syndrome: Insights From the Triton-TIMI 38 Trial
BACKGROUND: Reduction of LDL cholesterol with intensive lipid-lowering therapy (I-LLT) reduces CV ischemic events after an acute coronary syndrome (ACS). Data suggest that despite benefits, I-LLT is underutilized.
Methods: We investigated the use and correlates of I-LLT recorded at 24hrs post-PCI in 13,544 ACS subjects in the TRITON-TIMI 38 trial. I-LLT was defined as rosuvastatin 10 or 20mg, atorvastatin 40 or 80mg, simvastatin 80mg, or any statin in combination with ezetimibe. LI-LLT (less intensive lipid-lowering therapy) was defined as statin therapy not meeting I-LLT criteria. A multivariate logistic regression was used to determine correlates of I-LLT utilization post-PCI. Analysis of LLT utilization during the 12 months after index ACS was performed. All endpoints were adjudicated by a blinded Clinical Endpoints Committee.
Results: Post-PCI, 26% of this ACS cohort was treated with I-LLT, 62% with LI-LLT, and 12% without statin therapy. Use of I-LLT was only 30% for patients with LDL-C ≥ 160mg/dL in the entire cohort. I-LLT utilization varied across regions: 41%North America, 23% Western Europe, 19% Eastern Europe, 11% South America and 16% Rest of World. The strongest correlates of I-LLT utilization were admission lipid-modifying therapy and region. Subjects admitted on I-LLT were much more likely to be treated with I-LLT (OR= 24.2; 95% CIs 17.6-33.4); while subjects admitted on LI-LLT were much less likely compared to those not on statin therapy at admission (OR=0.34; 95% CIs 0.29-0.40). In comparison to NA, subjects in WE (OR= 0.34; 95% Cls 0.30-0.39), EE (OR= 0.27; 95% CIs 0.24-0.31), SA (OR= 0.13; 95% CIs 0.09-0.19), and ROW (OR= 0.20; 95% CIs 0.17-0.24), were less likely to be given I-LLT. At 360 days, 28.6% on the total cohort was on I-LLT, with only 4.5% of subjects not on any statin therapy. Of those subjects originally treated with I-LLT, 5.8% were downtitrated to LI-LLT and 0.2% of these subjects were discontinued from statin therapy.
CONCLUSION: This analysis suggests use of I-LLT was largely determined by LLT on admission and by region. Underutilization of I-LLT was apparent in those subjects with the highest baseline LDL-C levels. These findings indicate the need for further evaluation of I-LLT utilization in contemporary practice.
- © 2013 by American Heart Association, Inc.