Abstract Background According to the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias icosapent ethyl (IPE) should be considered in high or very high-risk patients with hypertriglyceridemia to further lower the residual cardiovascular risk. Purpose We examined the proportion of patients with a recent hospitalization for acute coronary syndrome (ACS) who are candidates for IPE administration and the association between IPE eligibility status and cardiovascular outcomes. Methods CALLINICUS-Hellas Registry is an ongoing prospective multicenter observational study evaluating the adherence to lipid-lowering therapy among ACS patients in Greece. Patients who had their lipid profile reevaluated at 6 months post-ACS were included in this analysis. Two groups were created according to IPE eligibility which was based on elevated triglycerides levels (135-499 mg/dL) despite statin treatment. The study’s endpoint was the development of non-fatal myocardial infarction (MI). Kaplan-Meier and multivariate cox regression analyses were used to assess study outcomes. Results A total of 1254 consecutive patients with ACS were included and non-fatal MI occurred in 48 cases (3.8%). At discharge the vast majority (99%) of patients were on statin. Overall, 25.6% (n=321) of the patients were IPE candidates. Traditional risk factors such as hypertension, dyslipidemia and diabetes mellitus were more prevalent among IPE eligible patients. They were also younger with higher body mass index as compared to IPE ineligible counterparts. Both study groups received comparable treatment strategies during hospitalization (invasive and medical therapies). Lipid profile and pharmacotherapy during follow-up are given in Table 1. IPE eligible patients were more likely to suffer from recurrent MI (5.9% vs 3.1%, p=0.02, see also Figure 1). Importantly, IPE eligibility remained an independent predictor for non-fatal MI after adjustment for age, hypertension, male gender, diabetes mellitus, dyslipidemia, multivessel disease at index event (luminal diameter reduction ≥50% in at least two major coronary arteries) and smoking persistence (hazard ratio: 2.00; 95% confidence interval: 1.09-3.64; p=0.02). Conclusions In a series of contemporary ACS patients, IPE might be considered in one out of four patients shortly after the index event. IPE eligible patients are more likely to have adverse cardiometabolic features and are at increased risk for recurrent MI.Table 1 Figure 1
Papathanasiou et al. (Sat,) studied this question.