Coronary Artery Disease
Influence of High-Dose Highly Efficient Statins on Short-Term Mortality in Patients Undergoing Percutaneous Coronary Intervention With Stenting for Acute Coronary Syndromes

https://doi.org/10.1016/j.amjcard.2013.12.012Get rights and content

Statins are recommended for prevention of progression of cardiovascular disease after percutaneous coronary intervention (PCI). Although high-dose highly efficient statins are recommended, especially in high-risk patients, clinical data are scarce and further investigation in “real-world” settings is needed. One thousand five hundred twenty-eight consecutive patients, who underwent PCI for acute coronary syndrome, were included in a prospective registry from January 2003 to January 2011. In post hoc analysis, cardiovascular risk factors, co-morbidities, and circulating lipid parameters at the time of intervention were evaluated. As a primary end point, all-cause mortality after a follow-up period of 3 months was investigated. Results were compared between patients receiving high-dose highly effective statins (atorvastatin 80 mg or rosuvastatin 20 mg) versus patients receiving low-dose statins or who were without lipid-lowering therapy at the time of discharge. Nine hundred twenty-six patients (60.6%) received high-dose atorvastatin or rosuvastatin and 602 patients (39.4%) received low-dose statin therapy or were not on statins at discharge. Eight patients (0.9%) receiving high-dose statin therapy and 21 patients (3.5%) taking low-dose statins or no statins at discharge died during the 3-month follow-up (hazard ratio 0.244, 95% confidence interval 0.108 to 0.551, p = 0.001). After propensity score adjustment the results remained significant (adjusted hazard ratio for high-dose statins 0.405, 95% confidence interval 0.176 to 0.931, p = 0.033). In conclusion, in this single-center series of 1,528 real-world patients undergoing PCI for acute coronary syndrome, a significant reduction in short-term all-cause mortality could be demonstrated in patients receiving high-dose highly efficient statins compared with patients receiving low-dose statins or no lipid-lowering therapy.

Section snippets

Methods

In total, 1,528 consecutive patients, who underwent PCI for ACS, were included in a prospective registry from January 2003 to January 2011. Eighty-one patients (52.4%) had an ST elevation myocardial infarction (STEMI) and 727 (47.6%) had a non-STEMI at presentation. In post hoc analysis, cardiovascular risk factors, co-morbidities, and basal circulating lipid variables (total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides) at the time of the index event were

Results

Nine hundred twenty-six patients (60.6%) received high-dose atorvastatin (91.9%) or rosuvastatin (8.1%) and 602 patients (39.4%) received low-dose statin therapy with lower doses of atorvastatin, rosuvastatin, or different statins, or were not on statins at discharge due to normal cholesterol levels. Their baseline mean plasma levels of lipid variables are listed in Table 1. Sixty-six patients (7.1%) with high-dose statins and 44 patients (9.1%) with low-dose statins or without statin (p =

Discussion

In this post hoc analysis of a prospective registry, we were able to demonstrate that high-dose highly effective statins can reduce short-term all-cause mortality in patients with ACS treated with PCI plus stent implantation. This benefit was especially seen in patients with diabetes, renal dysfunction, and STEMI at presentation.

The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study4 and the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis

Disclosures

The authors have no conflicts of interest to disclose.

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    This work was supported by the Association for the Promotion of Scientific Research in Arteriosclerosis, Thrombosis and Vascular Biology (ATVB), Vienna, Austria.

    See page 1103 for disclosure information.

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