title: Clinical outcome of statin plus ezetimibe versus high-intensity statin therapy in patients with acute myocardial infarction propensity-score matching analysis.
abstract: BACKGROUND
  It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor.
  
  
  METHODS
  A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up.
  
  
  RESULTS
  In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis.
  
  
  CONCLUSIONS
  In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Mi Seon
authors.initials: MS
authors.lastname: Ji
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Ahn
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Yeungnam Univ. Hosp., Daegu, Republic of Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Kyungpuk National Univ. Hosp., Daegu, Republic of Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Busan National Univ. Hosp., Busan, Republic of Korea.
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Chungnam National Univ. Hosp., Daejon, Republic of Korea.
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.affiliation: Chunbuk National Univ. Hosp., Jeonju, Republic of Korea.
authors.forename: Jei Keon
authors.initials: JK
authors.lastname: Chae
authors.affiliation: KyungHee Univ. Hosp., Seoul, Republic of Korea.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Korea University Guro Hospital, Seoul, Republic of Korea.
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: Konyang University, Daejon, Republic of Korea.
authors.forename: Jang Ho
authors.initials: JH
authors.lastname: Bae
authors.affiliation: Catholic Univ. Hosp., Seoul, Republic of Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000639:trends; D004359:Drug Therapy, Combination; D000069438:Ezetimibe / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D057216:Propensity Score; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
keywords: Ezetimibe simvastatin combination; Myocardial infarction; Statins