Adherence to lipid lowering therapy in post-ACS patients during 3 years follow up

Abstract

Objective: to evaluate long-term efficacy and adherence to therapy with statins in patients with acute coronary syndrome (ACS).
Material and methods: in a register-based retrospective study included 458 patients with ACS. During hospitalization 257 (56,1%) patients underwent successful percutaneous coronary intervention (PCI). At 148 (32,3%) patients at admission to the hospital revealed renal dysfunction (RD) – glomerular filtration rate (GFR <60 ml/min/1,73 m2, 75 (16,4%) – diabetes mellitus (DM). Satin for the first year of observation took 63,3% (n=290) from all included patients. After determination of compliance a year after the ACS assessed the incidence of «endpoints» within the next two years of observation. Revealed that the frequency of two-year cardiovascular mortality was 8,1% (n=37), and the total mortality 9,6% (n=44).
Results: the 4 comparison groups based on treatment strategies and the presence or absence of RD. In the I group included 184 patients without RD and with successful PCI; in II – 73 patients with RD and PCI; III – 126 of patients without RD and with a conservative treatment strategy; IV – 75 patients with RD and initial conservative treatment strategy, which survived to the 12th month of observation. The acceptance of statins in group IV reduced the relative risk (RRR) of cardiovascular death within two years of follow-up to 88,3% (p=0,01). In the I group therapy significantly (p=0,01) was associated with a decrease in General (RRR=71,5%), but not cardiovascular, mortality. In groups II and III revealed only a tendency to decrease the frequency of «end points» for 24 months in patients receiving statins. In patients with diabetes receiving statins were less effective than in patients without diabetes. Thus, the RRR for total and cardiovascular death in patients without DM was, respectively, at 62,8% (p=0,003) and 66.0% (p=0,003).
Conclusion. We identified groups of patients with different efficacy of statin therapy. Only 2/3 of patients during the year after ACS took statins and a reduction in the frequency of their admission was associated not only with aging but also with failure as coronary angiography during hospitalization, and surgical myocardial revascularization in the three years of observation. All of the above facts dictate the need to study such patients additional opportunities to improve prognosis and adherence to therapy (e.g., added to statin therapy, PCSK9 inhibitors).