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Impact of statin usage patterns on outcomes after percutaneous coronary intervention in acute myocardial infarction: Korea Working Group on Myocardial Infarction registry (KorMI) study.
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PMID:  25009557     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The benefit of statin use after acute ST-segment elevation myocardial infarction (STEMI) has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention (PCI).
METHODS: This analysis of the Korea Working Group on Myocardial Infarction registry (KorMI) study included 3,584 STEMI patients (mean age, 63 ± 13 years; male, 2,684, 74.9%) undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events (MACE: all-cause death, recurrent MI, and target lesion revascularization) were compared among patients grouped according to statin therapy timing: I, both during and after hospitalization (n = 2,653, 74%); II, only during hospitalization (n = 309, 8.6%); III, only after discharge (n = 157, 4.4%); and IV, no statin therapy (n = 465, 13%). Mean follow-up duration was 234 ± 113 days.
RESULTS: Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups III and IV had the highest MACE rates (2.3%, 3.9%, 5.1%, and 4.9% for groups I-IV, respectively, P = 0.004). After adjusting for confounders, groups II-IV had a higher MACE risk than group I [hazard ratio (HR): 3.20, 95% confidence interval (95%CI): 1.31-7.86, P = 0.011; HR: 3.84, 95%CI: 1.47-10.02, P = 0.006; and HR: 3.17, 95%CI: 1.59-6.40, P = 0.001; respectively].
CONCLUSIONS: This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical practice.
Authors:
Chan-Hee Lee; Sang-Hee Lee; Jong-Seon Park; Young-Jo Kim; Kee-Sik Kim; Shung-Chull Chae; Hyo-Soo Kim; Dong-Ju Choi; Myeong-Chan Cho; Seung-Woon Rha; Myung-Ho Jeong;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of geriatric cardiology : JGC     Volume:  11     ISSN:  1671-5411     ISO Abbreviation:  J Geriatr Cardiol     Publication Date:  2014 Jun 
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Created Date:  2014-07-10     Completed Date:  2014-07-10     Revised Date:  2014-07-14    
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Nlm Unique ID:  101237881     Medline TA:  J Geriatr Cardiol     Country:  China    
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Languages:  eng     Pagination:  93-9     Citation Subset:  -    
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Journal ID (nlm-ta): J Geriatr Cardiol
Journal ID (iso-abbrev): J Geriatr Cardiol
Journal ID (publisher-id): JGC
ISSN: 1671-5411
Publisher: Science Press
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Received Day: 5 Month: 4 Year: 2014
Revision Received Day: 13 Month: 5 Year: 2014
Accepted Day: 20 Month: 5 Year: 2014
Print publication date: Month: 6 Year: 2014
Volume: 11 Issue: 2
First Page: 93 Last Page: 99
PubMed Id: 25009557
ID: 4076447
Publisher Id: jgc-11-02-093
DOI: 10.3969/j.issn.1671-5411.2014.02.010

Impact of statin usage patterns on outcomes after percutaneous coronary intervention in acute myocardial infarction: Korea Working Group on Myocardial Infarction registry (KorMI) study
Chan-Hee Lee1
Sang-Hee Lee1
Jong-Seon Park1
Young-Jo Kim1
Kee-Sik Kim2
Shung-Chull Chae3
Hyo-Soo Kim4
Dong-Ju Choi5
Myeong-Chan Cho6
Seung-Woon Rha7
Myung-Ho Jeong8
other Korea Working Group on Myocardial Infarction (KorMI) Investigators
1Department of Cardiology, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu, 705-717, South Korea
2Department of Internal Medicine, Daegu Catholic University Hospital, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 705-718, South Korea
3Department of Internal Medicine, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 700-721, South Korea
4Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
5Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173-gil, Bundang-gu, Seongnam, 463-707, South Korea
6Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Heungdeok-gu, Cheongju, 361-711, South Korea
7Department of Internal Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
8Department of Internal Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
Correspondence: Correspondence to: Jong-Seon Park, MD, PhD, Department of Cardiology, Yeungnam University Hospital 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, South Korea. E-mail: pjs@med.yu.ac.krTelephone:+82-53-6213310Fax:+82-53-620-3847

Introduction

Statins, the 3-hydroxy-3-methylglutaryl coenzyme A (HMG Co-A) reductase inhibitors, reduce the risk of recurrent coronary events and improve survival in patients after acute myocardial infarction (AMI).[1] Statin use in pa-tients undergoing percutaneous coronary intervention (PCI) appears beneficial in terms of early and intermediate-term mortality;[2] statin therapy initiated at discharge significantly reduces 1-year mortality after primary angioplasty for ST-segment elevation myocardial infarction (STEMI);[3] and statin discontinuation in first-AMI survivors is associated with higher all-cause mortality when compared with non-users.[4] However, lipid-lowering medications remain underutilized in real-world practice, and the impact of timing patterns of statin use on survival after AMI is unknown. This study assessed whether timing of statin use, i.e., during hospitalization and/or after discharge or no use, influences early outcomes after acute STEMI, particularly in patients undergoing PCI.


Methods
2.1  Study population

This study is based on a database collected by the national registry study of the Korea Working Group on Myocardial Infarction (KorMI). KorMI is a prospective, multi-center registry study designed to characterize the clinical characteristics and prognosis of AMI in Korean patients. All 52 cardiology centers in Korea were invited to participate in the KorMI study, with support from the Korean Society of Cardiology in January 2008. At participating sites, consecutive patients admitted with AMI were asked to register as part of this study. The study protocol was reviewed and approved by the institutional review board at each participating center. Detailed data were obtained on the demographics of patients, treatment in the emergency room, catheterization findings, and the clinical outcome during their hospital stay. Data were collected at each institution; a study coordinator or doctor entered the data into a password-protected, web-based, computerized database program provided by the KorMI committee.

A total of 7,732 patients with AMI were enrolled in the KorMI registry from January 2008 to June 2009. Of these patients, 3,584 patients were included in this study using the following criteria: newly diagnosed STEMI; hospital admission within 7 days of symptom onset; age > 20 years (mean age: 63 ± 13 years); all patients underwent PCI; and patients experiencing in-hospital mortality were excluded (n = 347). Patients were stratified into four groups according to the mode of statin usage and regardless of statin dosage or class as follows: Group I, statin therapy both during hospitalization and after discharge (n = 2,653, 74%); Group II, only during hospitalization (n = 309, 8.6%); Group III, only after discharge (n = 157, 4.4%); and Group IV, no statin therapy (n = 465, 13%).

2.2  Study outcome

The outcome of this study was a 6-month composite of major adverse cardiac events (MACE) including all-cause death, recurrent MI, and target lesion revascularization (TLR). MI was defined as typical ischemic chest pain, ST-segment or T-wave abnormalities with a creatinine kinase-MB level ≥ 2 times the reference value. TLR was defined as surgical or percutaneous re-intervention driven by significant (> 50%) luminal narrowing within a stent or within 5 mm proximal or distal to a stent in the presence of angina symptoms, or objective evidence of ischemia. Only the first MACE was considered as the MACE of a patient.

2.3  Statistical analysis

Data were analyzed with SPSS for Windows, release 17.0 (SPSS Inc., Chicago, IL, USA). All descriptive data are expressed as mean ± SD. Comparisons of continuous and categorical variables between groups were analyzed by t test (2-sided) and Chi-square test, respectively. P < 0.05 were considered statistically significant. Long-term mortality was estimated using Kaplan-Meier techniques, and the impact of statin therapy as a time-dependent covariate on patient outcome was evaluated with the Cox proportional hazards regression model. Univariate Cox regression analysis was performed to evaluate the influence of variables on 6-month MACE. Multivariate logistic regression analysis was used to adjust for all MACE-associated variables with a P < 0.20 on univariate analysis.


Results

Mean follow-up duration was 234 ± 113 days. Among baseline characteristics, age, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), prior PCI, Killip class > 1, left ventricular ejection fraction (LVEF) < 45%, systolic and diastolic blood pressure (BP), and prior statin use were significantly different among the four groups (Table 1). Statin use during hospitalization was influenced by prior statin use, disease severity, and several laboratory findings. Angiographic findings were not significantly different among the four groups, except for the rate of achievement of final Thrombolysis In the Myocardial Infarction (TIMI) flow grade III (Table 2). Table 3 shows differences in medication use among the four groups during hospitalization and after discharge. Statins were less frequently dispensed in more severely diseased patients not taking other medications. On multivariate logistic regression analysis, statin use during hospitalization appeared to be influenced by several factors, including prior statin use, multiple diseased vessels, TIMI flow grade III after PCI, and LDL-C level (Table 4).

At 6-month follow-up, Groups III and IV had higher MACE rates (2.3%, 3.9%, 5.1%, and 4.9% for Groups I-IV, respectively, P = 0.004), (Figure 1). Patients on statin medication during and/or after hospitalization had better clinical outcomes than statin-naïve patients at the six month follow-up (Figure 2). After adjusting for other MACE-associated factors, Cox-proportional hazard analysis revealed significantly increased MACE risks for Groups II-IV as compared with Group I [II: hazard ratio (HR): 3.20, 95% confidence interval (95% CI): 1.31–7.86, P = 0.011; III: HR: 3.84, 95% CI: 1.47–10.02, P = 0.006; and IV: HR: 3.17, 95% CI: 1.59–6.40, P = 0.001; respectively] (Table 5). Also, relative risk of MACE development in patients who discontinued statin at discharge was similar to that of patients who had not used statins (3.20 and 3.17 in Groups II and IV, respectively).


Discussion

It is known that statin therapy has early benefit on vascular cellular responses through pleiotropic mechanisms beyond its LDL-C lowering effects[5] including endothelial function improvement,[6] antithrombotic effects,[7] mobilization of bone marrow progenitor cells,[8] cardiac remodeling prevention,[9] antiarrhythmic effects,[10] and reduction of ischemia-reperfusion injury.[11] In a previous study performed by Celik, et al.[12] using TIMI frame count method, prior high-dose statin use at least six months before PCI in AMI patients had beneficial effects on coronary blood flow, possibly by improving microvascular dysfunction. In a randomized clinical trial, Stenestrand, et al.[13] showed that early initiation of statin treatment in AMI patients is associated with reduced 1-year mortality. In our study, early and prolonged statin use (Group I) was associated with significantly lower 6-month MACE rate than that of other groups with statin use only during hospitalization or after discharge, or without statin use (2.3% vs. 4.9%). Despite the compelling scientific and clinical trial evidence that early initiation of statins reduces mortality in patients after AMI,[13],[14] this life-saving therapy continues to be underutilized in real-world practice. In the present study, statin non-users or those discontinuing statin use also tended not to use or discontinue cardioprotective drugs, such as aspirin, clopidogrel, β-blockers, and ACEI. One could posit that the latter observation might be explained by the differences in baseline characteristics between groups, including older age, higher Killip class, high rate of ejection fraction below 45% and low systolic, diastolic BP. However, the relative large percentage (17.4%) of STEMI patients not on statins during their hospitalization and of those who discontinued statin at discharge (8.6%) cannot be fully explained by these baseline differences. Because statins are relatively safe drugs with relatively low rates of complications,[15] there do not seem to be potential contraindications or life-threatening conditions that would justify avoiding or discontinuing statins in all groups. The paradoxical underuse of statins among the highest-risk patients might be explained by the so called “risk-treatment mismatch”, i.e., a progressive decline in medication prescription with increased baseline cardiovascular risk and future probability of death in the real world. In other words, clinicians seem to avoid prescribing medications to patients perceived to have a short life expectancy.[16],[17] However, another main cause of non-use or discontinuation of statins is likely the insurance system. Hoogerbrugge, et al.[18] previously identified unfavorable insurance status as the most relevant nonclinical factor associated with less use of costly services, such as treatment with statins. In our study, TC and LDL-C levels were significantly different between Group I and other groups. Because the Korean insurance system allows use of statins only based on TC and LDL-C levels, low levels of these parameters are likely responsible for statin non-use or discontinuation.

Daskalopoulou, et al.[4] in their large, observational, population-based study reported that statin discontinuation in first-AMI survivors was associated with higher all-cause mortality when compared with non-users. In the latter study, patients received 90 days of statin after AMI, and statin discontinuation was evaluated at 90 days after AMI. De Luca, et al.[19] reported that statin therapy initiation at discharge was associated with a significant reduction in 1-year mortality after primary angioplasty for STEMI. However, the impact of timing patterns of statin use during hospitalization and after discharge after AMI remained unclear. Moreover, comparison between statin-naïve patients and those who followed several patterns of statin use had not been studied well. In our study, after adjusting for compounding factors (Table 5), relative risk of MACE development in patients who discontinued statins at discharge was higher than that in patients continuing statin use after discharge (HR of 3.2 for Group II relative to Group I). In addition, relative risk of MACE was similar between the statin-discontinuation group and the statin-naïve group (HR 3.20 in Group II vs. 3.17 in Group IV). Non-use of statin therapy after AMI appears to be associated with higher mortality than any other pattern of statin administration (Figure 1). This finding is consistent with those of clinical studies showing that the beneficial effects of statins are rapidly lost and often transiently reversed when statins are acutely discontinued.[20] In a previous study using data from the National Registry of Myocardial Infarction 4, patients who continued or newly started statin treatment had a decreased risk of in-hospital mortality; however, discontinuation of statins was associated with a higher risk of in-hospital mortality (compared with no statin use).[21] In patients with non-ST-segment elevation AMI discontinuation during the first 24 h was associated with a 2-fold risk when compared with continuation of statin treatment.[22] On the other hand, data from the Treating New Targets study suggested that short-term discontinuation of statin therapy in patients with stable cardiac conditions may not substantially increase the risk of acute coronary syndromes.[23] However, neither of these studies showed the relative long-term (six months) impact of statin discontinuation at discharge in unstable post-STEMI patients treated with PCI compared with various modes of statin use.

Our study underscores the clinical importance of statin therapy during hospitalization and after discharge in STEMI patients, in particular, those who underwent PCI. The discontinuation of statins in post-STEMI patients was associated with a high rate of MACE. This result appears to be driven not by the lipid-lowering effects of statins, but by reversal of statin pleiotropic effects after their discontinuation. The reasons for not using or discontinuing statins in the real world appear secondary to risk-treatment mismatch, and in large part, to the inappropriate health insurance system. Therefore, physicians need to recognize the benefit of statin use and should be very careful with statin discontinuation at patient discharge, especially in post-STEMI patients. Also remedial action of the health insurance system, now only focused on TC and LDL-C, is needed.

Our study has several limitations. This study is limited by the large differences in baseline clinical characteristics among groups studied (such as age, previous medical history, lipid profiles, Killip class, LVEF, BP, rates of prior statin use), the lack of differentiation of statin properties according to class (lipophilic or hydrophilic) or dosage (high vs. low), its non-randomized, non-controlled design, and the inability to adjust for all confounders. Also, we could not confirm whether patients who were prescribed statins at hospital discharge continued using them throughout long-term follow-up. Because this study was based on registry data and data collection was voluntary at each participating center, the follow-up data were partially incomplete.

In conclusion, this study suggested that early and continuous use of statins improved early outcomes in acute STEMI survivors who underwent PCI in real-world clinical practice. This study was valuable since it was based on the national registry database, including a large sample size, multicenter design, and prospective data collection.


References
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7. Sanguigni V,Pignatelli P,Lenti L,et al. Short-term treatment with atorvastatin reduces platelet CD40 ligand and thrombin generation in hypercholesterolemic patientsCirculationYear: 200511141241915687128
8. Suzuki G,Iyer V,Cimato T,et al. Pravastatin improves function in hibernating myocardium by mobilizing CD133+ and cKit+ bone marrow progenitor cells and promoting myocytes to reenter the growth phase of the cardiac cell cycleCirc ResYear: 200910425526419096024
9. Liao Y,Zhao H,Ogai A,et al. Atorvastatin slows the progression of cardiac remodeling in mice with pressure overload and inhibits epidermal growth factor receptor activationHypertens ResYear: 20083133534418360054
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11. Di Napoli P,Taccardi AA,Grilli A,et al. Chronic treatment with rosuvastatin modulates nitric oxide synthase expression and reduces ischemia-reperfusion injury in rat heartsCardiovasc ResYear: 20056646247115914111
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13. Stenestrand U,Wallentin L. Early statin treatment following acute myocardial infarction and 1-year survivalJAMAYear: 200128543043611242427
14. Lenderink T,Boersma E,Gitt AK,et al. Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on Acute Coronary SyndromesEur Heart JYear: 2006271799180416820364
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16. Lee DS,Tu JV,Juurlink DN,et al. Risk-treatment mismatch in the pharmacotherapy of heart failureJAMAYear: 20052941240124716160132
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Figures

[Figure ID: jgc-11-02-093-g001]
Figure 1.  Clinical outcomes at 6-month follow up.

Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy. MACE: major adverse cardiac events; MI: myocardial infarction; TLR: target lesion revascularization.



[Figure ID: jgc-11-02-093-g002]
Figure 2.  MACE-free survival curves according to pattern of statin use.

Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy. MACE: major adverse cardiac events.



Tables
[TableWrap ID: jgc-11-02-093-t01] Table 1.  Baseline characteristics.
Variable Pattern of statin therapy use
P
Group I Group II Group III Group IV
(n = 2,653) (n = 309) (n = 157) (n = 465)
Age, yrs 62 ± 13 63 ± 12 64 ± 14 66 ± 13 < 0.001
Male 2,010 (76) 213 (69) 119 (76) 342 (74) 0.071
Risk factor (%)
 Hypertension 1,194 (46) 149 (49) 77 (50) 204 (45) 0.439
 Diabetes mellitus 599 (23) 92 (30) 30 (20) 123 (27) 0.007
 Current smoker 1,260 (49) 129 (44) 76 (50) 195 (44) 0.048
Lipid profile
 TC, mg/dL 188 ± 44 178 ± 46 181 ± 45 168 ± 41 < 0.001
 Triglycerides, mg/dL 133 ± 102 133 ± 98 133 ± 135 116 ± 108 0.016
 HDL-C, mg/dL 44 ± 13 44 ± 17 45 ± 17 43 ± 13 0.124
 LDL-C, mg/dL 121 ± 38 112 ± 39 115 ± 34 103 ± 35 < 0.001
Prior PCI 100 (4) 23 (7) 6 (4) 18 (4) 0.022
Prior angina pectoris 94 (4) 10 (3) 3 (2) 10 (2) 0.335
Prior CABG 6 (0.2) 0 0 1 (0.2) 0.789
Prior stroke 153 (6) 22 (7) 3 (2) 27 (6) 0.147
CHF NYHA class > 2 16 (0.6) 4 (1.3) 2 (1.3) 5 (1.1) 0.358
Killip class > 1 744 (31) 100 (35) 37 (26) 172 (41) < 0.001
LVEF < 45% 363 (15) 43 (19) 18 (13) 86 (23) 0.002
Systolic BP 129 ± 29 125 ± 31 124 ± 25 119 ± 31 < 0.001
Diastolic BP 79 ± 18 77 ± 19 76 ± 17 73 ± 20 < 0.001
Prior statin use 154 (6) 18 (6) 3 (2) 15 (3) 0.028

nt101Results are presented as mean ± SD or n (%). Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy. BP: blood pressure; CABG: coronary artery bypass graft; CHF: congestive heart failure; HDL-C: high-density lipoprotein-cholesterol; LDL-C: low-density lipoprotein-cholesterol; LVEF: left ventricular ejection fraction; NYHA: New York Heart Association; PCI: percutaneous coronary intervention; TC: total cholesterol.


[TableWrap ID: jgc-11-02-093-t02] Table 2.  Angiographic findings.
Variable Pattern of statin therapy use
P
Group I Group II Group III Group IV
(n = 2,653) (n = 309) (n = 157) (n = 465)
> 1 Diseased vessel 1,363 (53) 168 (56) 71 (48) 224 (53) 0.511
Infarct related artery 0.412
 Left anterior descending 1,341 (52) 155 (52) 76 (52) 199 (47)
 Left circumflex 271 (11) 33 (11) 22 (15) 49 (12)
 Right coronary 934 (36) 107 (36) 47 (32) 167 (39)
 Left main 30 (1) 5 (2) 2 (1) 9 (2)
 Lesion type C 1,065 (48) 128 (51) 58 (46) 147 (43) 0.132
Stent length > 30 mm 554 (23) 50 (20) 26 (20) 84 (22) 0.644
Stent diameter ≤ 3.0 mm 523 (22) 48 (19) 27 (21) 72 (19) 0.57
Final TIMI 3 flow 2,171 (92) 223 (86) 123 (92) 308 (83) < 0.001

nt102Results are presented as n (%). Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy. TIMI: Thrombolysis In Myocardial Infarction.


[TableWrap ID: jgc-11-02-093-t03] Table 3.  Medications during hospitalization and after discharge.
Variable Pattern of statin therapy use
P
Group I Group II Group III Group IV
(n = 2,653) (n = 309) (n = 157) (n = 465)
During hospitalization
 Aspirin 2,641 (100) 307 (99) 143 (99) 424 (98) 0.001
 Clopidogrel 2,631 (100) 306 (99) 142 (99) 423 (98) 0.061
 Beta-blocker 2,183 (82) 248 (80) 93 (59) 313 (67) < 0.001
 ACEI 1,916 (72) 196 (63) 79 (50) 262 (56) < 0.001
 ARB 486 (18) 63 (22) 31 (20) 85 (18) 0.526
After discharge
 Aspirin 2,682 (99) 183 (61) 156 (99) 371 (80) < 0.001
 Clopidogrel 2,362 (89) 170 (55) 143 (91) 330 (71) < 0.001
 Beta-blocker 2,155 (81) 145 (47) 119 (76) 280 (60) < 0.001
 ACEI 1,780 (67) 115 (37) 86 (55) 226 (49) < 0.001

nt103Results are presented as n (%). Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy. ACEI: angiotensin-converting-enzyme inhibitors; ARB: angiotensin II receptor blockers.


[TableWrap ID: jgc-11-02-093-t04] Table 4.  The factors associated with statin use during hospitalization (Multivariate analysis).
Variable Exp (β) 95% CI
P
Lower Upper
Prior statin use 0.052 0.007 0.408 0.005
> 1 diseased vessel 1.524 1.110 2.092 0.009
Lesion type C 1.345 0.972 1.861 0.074
Final TIMI 3 flow 0.392 0.232 0.664 < 0.001
LDL-C (mg/dL) 1.013 1.003 1.022 0.010

nt104Age, sex, history of diabetes mellitus and hypertension, current smoking, lipid profile, LVEF, prior statin use, > 1 diseased vessel, Lesion type C, stent length and stent diameter, Final TIMI 3 flow were used as covariates in the model. LDL-C: low-density lipoprotein-cholesterol; LVEF: left ventricular ejection fraction; TIMI: thrombolysis in myocardial infarction.


[TableWrap ID: jgc-11-02-093-t05] Table 5.  Prognostic value of the pattern of statin therapy use for total adverse events at 6-month follow up.
Grouping Hazard ratio (95% CI)
Unadjusted P Adjusted P
Group I 1 1
Group II 3.19 (1.21–8.42) 0.019 3.2 (1.31–7.86) 0.011
Group III 4.77 (1.71–13.28) 0.003 3.84 (1.47–10.02) 0.006
Group IV 3.71 (1.71–8.0) 0.001 3.17 (1.59–6.40) 0.001

nt105Adjusted for age, gender, Killip class > I, blood pressures, left ventricular ejection fraction < 45%, and co-morbidities (previous myocardial infarction, angina pectoris, heart failure, hypertension, diabetes, smoking history, increased lipid levels, stroke, and peripheral vascular disease), medications before and after discharge, reperfusion therapies (primary percutaneous coronary intervention, thrombolytic therapy, and overall percutaneous coronary intervention), angiographic findings (multivessel disease, target vessel, lesion type C, and stent insertion), and complications. Patterns of statin therapy use: Group I, statin therapy both during hospitalization and after discharge; Group II, only during hospitalization; Group III, only after discharge; and Group IV, no statin therapy.



Article Categories:
  • Research Article

Keywords: Statins, Acute myocardial infarction, Treatment outcome.

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