부산대학교 도서관

Background: Patients with a prior history of coronary artery bypass grafting (CABG) are at high risk for future ischemic events despite statin therapy.Methods: REDUCE-IT, a multicenter, double-blind, placebo-controlled trial, randomized statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled LDL (41-100 mg/dL), and either established cardiovascular disease or diabetes plus other risk factors to receive icosapent ethyl 4g daily or placebo. In the overall trial, the primary composite endpoint (cardiovascular death, myocardial infarction, stroke, coronary revascularization, hospitalization for unstable angina) and the key secondary composite endpoint (cardiovascular death, myocardial infarction, stroke) were significantly reduced. Here we examine the subgroup of patients with a history of CABG.Results: A total of 8,179 randomized patients were followed for 4.9 years (median), 1837 (22.5%) of whom had a prior CABG, with a median of 5.1 years (0.7 months to 33.3 years) from CABG to randomization (in the 1263 patients who had the date of CABG recorded). The rate of the primary endpoint was reduced by 24% [22.0% with icosapent ethyl versus 28.2% with placebo (hazard ratio [HR]=0.76; 95% confidence interval [CI], 0.63-0.92; p=0.004; number needed to treat [NNT]=16)]. The rate of the key secondary endpoint was reduced by 31%: [14.7% with icosapent ethyl versus 20.7% with placebo (HR=0.69; 95% CI, 0.56-0.87; p=0.001; NNT=17)].Conclusions: In statin-treated patients with a history of prior CABG, the addition of icosapent ethyl significantly reduced ischemic events, with both large relative and absolute risk reductions.