title: Early initiation of eicosapentaenoic acid and statin treatment is associated with better clinical outcomes than statin alone in patients with acute coronary syndromes: 1-year outcomes of a randomized controlled study.
abstract: BACKGROUND
  Early initiation of EPA treatment in combination with a statin within 24h after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) reduces inflammation and ventricular arrhythmia compared with statin monotherapy; however, the impact of early initiation of EPA treatment on cardiovascular events is unclear. We determined whether early eicosapentaenoic acid (EPA) treatment in patients with acute coronary syndrome (ACS) reduces adverse cardiovascular events.
  
  
  METHODS
  This prospective, open-label, blind end point-randomized trial consisted of 241 patients with ACS. Patients were randomly assigned to receive pitavastatin (2mg/day) with or without 1800mg/day of EPA initiated within 24h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1year, including death from a cardiovascular cause, nonfatal stroke, nonfatal MI and revascularization.
  
  
  RESULTS
  The mean EPA/arachidonic acid ratio at follow-up was 0.40 in the control group and 1.15 in the EPA group. A primary endpoint event occurred in 11 patients (9.2%) in the EPA group and 24 patients (20.2%) in the control group (absolute risk reduction, 11.0%; hazard ratio, 0.42; 95% confidence interval, 0.21 to 0.87; P=0.02). Notably, death from a cardiovascular cause at 1year was significantly lower in the EPA group than in the control group (0.8% vs. 4.2%, P=0.04).
  
  
  CONCLUSIONS
  Early initiation of treatment with EPA combined with statin after successful primary PCI reduced cardiovascular events after ACS.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm.
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: kn_orch@yahoo.co.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Nosaka
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan. Electronic address: torumiyoshi@hotmail.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: mutsum0808@yahoo.co.jp.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Iwamoto
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: kajiyanneko@yahoo.co.jp.
authors.forename: Masahito
authors.initials: M
authors.lastname: Kajiya
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: k-ookawa@chp-kagawa.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okawa
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: enokitsukudani@yahoo.co.jp.
authors.forename: Saori
authors.initials: S
authors.lastname: Tsukuda
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: kagawakenntakamatsusimiyawakicho@yahoo.co.jp.
authors.forename: Fumi
authors.initials: F
authors.lastname: Yokohama
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: msogo0517@gmail.com.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sogo
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: iwgp.west.24be@gmail.com.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nishibe
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: monkey1mastuo@gmail.com.
authors.forename: Naoaki
authors.initials: N
authors.lastname: Matsuo
authors.affiliation: Department of Medical Technology, Okayama University Graduate School of Health, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan. Electronic address: hirohas@cc.okayama-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirohata
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan. Electronic address: itomd@md.okayama-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan. Electronic address: mdoimd@gmail.com.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Doi
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015118:Eicosapentaenoic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011804:Quinolines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011804:Quinolines; D015118:Eicosapentaenoic Acid; C108475:pitavastatin
keywords: Cardiovascular diseases; Catheterization; Fatty acids, statins; Infarction; Inflammation