Kytö Ville, Tornio Aleksi
Heart Center Turku University Hospital and University of Turku, Turku, Finland.
Turku Clinical Research Center, Turku University Hospital, Turku, Finland.
Am J Prev Cardiol. 2024 Jun 23;19:100702. doi: 10.1016/j.ajpc.2024.100702. eCollection 2024 Sep.
The inhibition of intestinal cholesterol absorption by ezetimibe improves outcomes after myocardial infarction (MI), yet real-world data on ezetimibe is scarce. We studied the usage of ezetimibe and association with outcome after MI.
Consecutive MI patients in Finland (2010-2018) were retrospectively studied ( = 57,505; 65 % men; mean age 69 years). The study data were collected from national registries. The median follow-up was 4.5 (IQR 2.8-7.1) years. Between-group differences were adjusted for using multivariable regression. Ezetimibe use was studied with competing risk analyses.
The cumulative incidence of ezetimibe use was 3.7 % at 90 days, 13.4 % at 5 years, and 19.8 % at 10 years. Younger age was one of the strongest predictors of ezetimibe use (adj.sHR 6.67; CI 5.88-7.69 for patients aged <60 vs ≥80 years). Women were more likely to use ezetimibe during follow-up than men. The average proportion of patients using ezetimibe during follow-up was 6.8 %. (11.7 % at 10 years). Ezetimibe was discontinued by 43.6 % of patients during follow-up. Patients with early ezetimibe therapy after MI had lower all-cause mortality during follow-up (33.6% vs 45.1 %; adj.HR 0.77; CI 0.69-0.86; < 0.0001). Early ezetimibe use was associated with lower mortality irrespective of sex, age, atrial fibrillation, diabetes, heart failure, malignancy, revascularization, or statin use. Ongoing ezetimibe therapy during follow-up was associated with lower mortality in a time-dependent analysis (adj.HR 0.53; CI 0.48-0.59; < 0.0001).
Ezetimibe is associated with a lower risk of death after MI, yet its therapeutic use is limited, and discontinuation is frequent.
依折麦布抑制肠道胆固醇吸收可改善心肌梗死（MI）后的预后，但关于依折麦布的真实世界数据却很匮乏。我们研究了依折麦布的使用情况及其与心肌梗死后预后的关联。
对芬兰2010年至2018年连续的心肌梗死患者进行回顾性研究（n = 57,505；65%为男性；平均年龄69岁）。研究数据从国家登记处收集。中位随访时间为4.5年（四分位间距2.8 - 7.1年）。组间差异通过多变量回归进行调整。使用竞争风险分析研究依折麦布的使用情况。
依折麦布使用的累积发生率在90天时为3.7%，5年时为13.4%，10年时为19.8%。年龄较小是依折麦布使用的最强预测因素之一（年龄<60岁与≥80岁患者相比，调整后风险比为6.67；95%置信区间为5.88 - 7.69）。随访期间女性比男性更有可能使用依折麦布。随访期间使用依折麦布的患者平均比例为6.8%（10年时为11.7%）。随访期间43.6%的患者停用了依折麦布。心肌梗死后早期接受依折麦布治疗的患者在随访期间全因死亡率较低（33.6%对45.1%；调整后风险比为0.77；95%置信区间为0.69 - 0.86；P < 0.0001）。无论性别、年龄、房颤、糖尿病、心力衰竭、恶性肿瘤、血运重建或他汀类药物使用情况如何，早期使用依折麦布均与较低的死亡率相关。在时间依赖性分析中，随访期间持续使用依折麦布与较低的死亡率相关（调整后风险比为0.53；95%置信区间为0.48 - 0.59；P < 0.0001）。
依折麦布与心肌梗死后较低的死亡风险相关，但其治疗应用有限，且停药情况频繁。
