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

Kazumasa Nosaka, Toru Miyoshi, Mutsumi Iwamoto, Masahito Kajiya, Keisuke Okawa, Saori Tsukuda, Fumi Yokohama, Masahiro Sogo, Tomoyuki Nishibe, Naoaki Matsuo, Satoshi Hirohata, Hiroshi Itoh, Masayuki Doi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Early initiation of EPA treatment in combination with a statin within 24 h 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 (2 mg/day) with or without 1800 mg/day of EPA initiated within 24 h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1 year, 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 1 year 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. Clinical Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm

Original languageEnglish
Pages (from-to)173-179
Number of pages7
JournalInternational Journal of Cardiology
Volume228
DOIs
Publication statusPublished - Feb 1 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Eicosapentaenoic Acid
Acute Coronary Syndrome
Percutaneous Coronary Intervention
Therapeutics
Control Groups
Registries
Myocardial Infarction
Clinical Trials
Numbers Needed To Treat
Myocardial Revascularization
Arachidonic Acid
Cardiac Arrhythmias
Stroke
Confidence Intervals
Inflammation

Keywords

  • Cardiovascular diseases
  • Catheterization
  • Fatty acids, statins
  • Infarction
  • Inflammation

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

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. / Nosaka, Kazumasa; Miyoshi, Toru; Iwamoto, Mutsumi; Kajiya, Masahito; Okawa, Keisuke; Tsukuda, Saori; Yokohama, Fumi; Sogo, Masahiro; Nishibe, Tomoyuki; Matsuo, Naoaki; Hirohata, Satoshi; Itoh, Hiroshi; Doi, Masayuki.

In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 173-179.

Research output: Contribution to journalArticle

Nosaka, Kazumasa ; Miyoshi, Toru ; Iwamoto, Mutsumi ; Kajiya, Masahito ; Okawa, Keisuke ; Tsukuda, Saori ; Yokohama, Fumi ; Sogo, Masahiro ; Nishibe, Tomoyuki ; Matsuo, Naoaki ; Hirohata, Satoshi ; Itoh, Hiroshi ; Doi, Masayuki. / 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. In: International Journal of Cardiology. 2017 ; Vol. 228. pp. 173-179.
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abstract = "Background Early initiation of EPA treatment in combination with a statin within 24 h 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 (2 mg/day) with or without 1800 mg/day of EPA initiated within 24 h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1 year, 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 1 year 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. Clinical Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm",
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author = "Kazumasa Nosaka and Toru Miyoshi and Mutsumi Iwamoto and Masahito Kajiya and Keisuke Okawa and Saori Tsukuda and Fumi Yokohama and Masahiro Sogo and Tomoyuki Nishibe and Naoaki Matsuo and Satoshi Hirohata and Hiroshi Itoh and Masayuki Doi",
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T1 - Early initiation of eicosapentaenoic acid and statin treatment is associated with better clinical outcomes than statin alone in patients with acute coronary syndromes

T2 - 1-year outcomes of a randomized controlled study

AU - Nosaka, Kazumasa

AU - Miyoshi, Toru

AU - Iwamoto, Mutsumi

AU - Kajiya, Masahito

AU - Okawa, Keisuke

AU - Tsukuda, Saori

AU - Yokohama, Fumi

AU - Sogo, Masahiro

AU - Nishibe, Tomoyuki

AU - Matsuo, Naoaki

AU - Hirohata, Satoshi

AU - Itoh, Hiroshi

AU - Doi, Masayuki

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background Early initiation of EPA treatment in combination with a statin within 24 h 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 (2 mg/day) with or without 1800 mg/day of EPA initiated within 24 h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1 year, 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 1 year 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. Clinical Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm

AB - Background Early initiation of EPA treatment in combination with a statin within 24 h 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 (2 mg/day) with or without 1800 mg/day of EPA initiated within 24 h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1 year, 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 1 year 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. Clinical Trial Registration: UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm

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KW - Catheterization

KW - Fatty acids, statins

KW - Infarction

KW - Inflammation

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