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Coronary disease & ACSCohort study

Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry

J Am Coll CardiolPublished

  • Registry-based cohort study
  • clone-censor-weight analysis
  • Cox proportional hazards models
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Authors' conclusion

delaying use of combination LLT or using high-intensity statin monotherapy is associated with avoidable harm.

Study context

Population
Lipid-lowering therapy (LLT)-naïve patients hospitalized for myocardial infarction (MI) (SWEDEHEART registry, 2015–2022) and discharged on statins
Participants
35,826 patients
Exposure
Early vs late vs no ezetimibe added to statins after MI
  • Earlyn = 6,040reference
  • Laten = 6,495
  • Nonen = 23,291
Outcome
MACE:
  • Death
  • MI
  • Stroke

Main finding

As reported in the abstract

MACE

Early

1.79 per 100 patient-years

1-year MACE incidence

Late

2.58 per 100 patient-years

1-year MACE incidence

None

4.03 per 100 patient-years

1-year MACE incidence

Each group vs earlyEstimate (95% CI)P value
Late1 year
weighted risk difference 0.6%(0.1%–1.1%)
P < 0.01
Late2 years
weighted risk difference 1.1%(0.3%–2.0%)
P < 0.01
Late3 years
weighted risk difference 0.7%(−0.2% to 1.3%)
P = 0.18
None1 year
risk difference 0.7%(0.2%–1.3%)
P for all <0.01
None2 years
risk difference 1.6%(0.8%–2.5%)
P for all <0.01
None3 years
risk difference 1.9%(0.8%–3.1%)
P for all <0.01
Each group vs earlyHazard ratio (95% CI)
Late3 years
1.14(0.95–1.41)
None3 years
1.29(1.12–1.55)
Patients with MACE over median 3.96 years (Q1-Q3: 2.15-5.81 years)
2,570

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
CV death · 3 years — Late vs Early1.64 (1.15–2.63)
CV death · 3 years — None vs Early1.83 (1.35–2.69)

Original publication

Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry. J Am Coll Cardiol. Published 22 April 2025. doi:10.1016/j.jacc.2025.02.007
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Summarised from the published abstract; every number is checked against it