Lipid Lowering Treatment and Follow up in Recent Post Acute Coronary Syndrome Patients: Real-World Evidence from the Multicenter Observational Prospective - Post Acute Coronary Syndrome Italian Study (PACSI)

• Main Authors: Pompilio Faggiano, Giuseppe Patti, Stefania Cercone, Laura Canullo, Roberta Rossini, Gian Piero Perna, Angela Pirillo, Francesco Fattirolli, Gianfranco Terrosu, Pier Luigi Temporelli, Alberico Catapano
• Format: Article
• Language: English
• Published: Barcaray International 2020-01-01
• Series: International Cardiovascular Forum Journal
• Subjects: ldl-c; lipid lowering treatment; statins; ezetimibe; acute coronary syndrome; esc/eas guidelines
• Online Access: https://icfjournal.org/index.php/icfj/article/view/639/pdf_1

Background Patients suffering from an acute coronary syndrome are at very high risk for recurrent events. Early targeted pharmacological intervention primarily aimed at controlling plasma LDL-cholesterol (LDL-C) levels can result in the reduction of recurrent cardiovascular events. This study aimed to evaluate real-life evidence from the Italian setting to document current practice of secondary prevention in patients after acute coronary syndrome (ACS), specifically assessing: (i) the rate of LDL-C target (<70 mg/dl) achievement after 6-10 weeks from index event and at later follow-up, (ii) the distance from LDL-C target during follow up, (iii) adherence rate and visit attendance. Methods Multicenter observational prospective clinical study ACS patients, evaluating target attainment rate at 6 weeks (V0) and 18 months (V2). Results Approximately 97.4% patients enrolled (N=524) received statin-based therapy, and 3.6% receivedezetimibe at discharge; mean LDL-C values decreased from 113.0±44.7 mg/dL at discharge to 71.3±26.5 mg/dl at V0. Among patients with known LDL-C for main time-points, 51.7% achieved target LDL-C at V0, 45.8% at V2. Among patients not reaching the target, the mean distance from target was 23.5±20.7 mg/dL. Attainment of target LDL-C was similar in patients receiving intensive or low-moderate statin-based treatment (approximately 50%). LDL-C target attainment was associated with lower LDL-C value at discharge and smoking status. Adherence to statin treatment was high (96.2%) throughout, similarly to medical appointment attendance at V2 (84.7%). Conclusions Despite most ACS patients receiving intensive statin-based regimens, only approximately half achieved LDL-C target, suggesting the need for further optimizing drug selection, combination and dosage.