The lipid lowering therapy of patients after intervention due to acute coronary syndrome and a recommendation for the further controls
The relevance of this treatment is underlined by the fact that in the recommendations published in 2019 the LDL-cholesterol (LDL-C) goal level in case of very high risk patients has been lowered from 1.8 to 1.4 mmol/l.
Aim: The evaluation of the lipid lowering therapy at the time of hospital discharge and the attainment of lipid levels in the first year after the intervention in a county hospital possessing hemodynamic possibilities.
Method: A retrospective data collection was performed in the database of the three hospitals of the county, regarding to therapy at discharge and the lipid levels followed over one year in case of patients undergone by coronary intervention due to ACS in 2017.
Results: We treated 513 patients with ACS in 2017, 38.6% of them suffered from ST segment elevation-, 56.5% with non-ST segment elevation myocardial infarction and 4.9% from unstable angina. The mean age was 67.9 years. At the time of hospital discharge 98.5% of patients got recommendation for statin treatment (1.5% for 20 mg rosuvastatin, 94% for 40 mg rosuvastatin and 3% for combination of 40 mg rosuvastatin + 10 mg ezetimibe). In the database of these hospitals, after 6 month of the discharge only 277 (54%), after one year 269 (52%) patients had lipid measurement results. The LDL-C average value (mmol/l, [IQ-range] was 1.97 (1.26–2.77) after half of a year, and 2.04 (1.29–2.36) after one year, the attainment rate of 1.8 mmol/l was 52.7% after 6 months of intervention, 48.0% after one year, the new target value –1.4 mmol/l was reached in 18.9% and after one year in 18.7% of patients.
Conclusions: The lipid lowering therapy suggested at discharge to patients suffering from ACS correlates with recommendations of the guidelines, but the goal attainment at half- and at one year is below of expectations. It would be advisable to give exact dates for the forthcoming control exams in the final report of patients treated with ACS and to give them a referral for the first lipid profile lab analysis at 4-6 weeks.