О.М. Parkhomenko, O.І. Irkin, Ya.M. Lutai, S.P. Kushnir, D.О. Bіlyi, A.О. Stepura. Comparative evaluation of efficacy and safety of the different modes of lipid-lowering therapy in acute myocardial infarction

The aim – to study the safety and effectiveness of early use of different modes of lipid-lowering therapy in patients with acute coronary syndrome (ACS) with ST-segment elevation.

Material and methods. The study involved 135 patients with acute coronary syndrome with ST segment elevation. Patients were assigned into 4 groups by random sampling: first – 26 patients, who received atorvastatin 10 mg and ezetimibe 10 mg, second – 24 patients, who received atorvastatin 40 mg, third – 43 patients treated with 80 mg of atorvastatin and fourth – 42 patients who received atorvastatin 40 mg and 10 mg of ezetimibe. All patients underwent stenting of the infarct related coronary artery.

Results. All patients showed an expected decrease of the average LDL level at the 10th, 90th and 180th days. More intensive reduction in LDL cholesterol was observed in the III and IV groups. In group III on the 90th day the average LDL cholesterol level decreased to 1.75±0.11 mmol/l and on the 180th day – 1.68±0.08 mmol/l. Patients of the Group IV on the 90th day achieved average level of LDL 1.55±0.09 mmol/l and on the 180th day – 1.61±0.10 mmol/l. Interruption of the drug was observed in groups I and II in 0.5 % of cases in groups III and IV in 4 %. Patients of groups I and II were significantly more likely to achieve combined endpoint during hospital period, compared to those in III and IV groups, 19.5 % and 7 %, respectively, Р=0.0281. Patients from groups I and II during the subsequent 90-day observation period significantly more often developed myocardial infarction, 7 % vs. 0 % Р=0.027 and more common – the combined end point of myocardial infarction or death, 8.8 % vs 1.4 % Р=0.042.

Conclusions. Statin therapy, and their combination with ezetimibe was well tolerated by patients with acute coronary syndrome with ST segment elevation. The recommended reduction in LDL-C to target values ​​was significantly more frequently noted in groups III and IV. High-intensity lipid-lowering therapy improved clinical course of ACS with ST-segment elevation in the hospital, and in the early post-hospital period.

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