Korean Circ J.  2011 Aug;41(8):458-463. 10.4070/kcj.2011.41.8.458.

Effect of Previous Statin Therapy in Patients With Acute Coronary Syndrome and Percutaneous Coronary Intervention

• Yun KH
• Shin IS
• Shin SN
• Choi JH
• Kim SH
• Rhee SJ
• Lee EM
• Yoo NJ
• Kim NH
• Oh SK
• Jeong JW

• KMID: 1826353
• DOI: http://doi.org/10.4070/kcj.2011.41.8.458

Abstract

BACKGROUND AND OBJECTIVES
Statin therapy after percutaneous coronary intervention (PCI) has been associated with reduced major adverse cardiovascular events (MACE). However, it has been less clear as to whether statin therapy before acute coronary syndrome (ACS) is beneficial. We studied the effect of previous statin therapy, initiated > or =1 month before PCI, on the outcome of patients with ACS who had undergone early invasive strategies.
SUBJECTS AND METHODS
We stratified 479 consecutive patients with ACS who had undergone PCI, according to preprocedural statin administration as follows: previous statin-treated patients (statin group, n=237) and statin-naive patients (control group, n=242). The incidence of periprocedural myocardial infarction (MI) and in-hospital MACE was assessed.
RESULTS
The incidence of Braunwald class III angina and MI presentation were significantly lower in the statin group than in the control group. Angiographic and procedural characteristics were similar between the two groups; however, slow/no reflow phenomenon occurred more frequently in the control group. After PCI, the incidence of periprocedural MI was higher in the control group than in the statin group (6.6% vs. 2.1%, p=0.016). Multivariate analysis revealed that no prior use of statin {odds ratio (OR)=2.8; 95% confidence interval (CI)=1.1-7.2; p=0.038), procedural complication (OR=4.0; 95% CI=1.5-10.5; p=0.004), stent overlap (OR=4.7; 95% CI=1.3-16.4; p=0.015), and old age (OR=3.2; 95% CI=1.2-8.0; p=0.016) were independent predictors for in-hospital MACE.
CONCLUSION
Previous statin therapy before ACS was associated with milder clinical presentation and lower incidence of in-hospital MACE after early invasive strategies. The beneficial outcome is attributable to a significant reduction in periprocedural MI after PCI.

Keyword

Angioplasty; Myocardial infarction; Stents; Hydroxymethylglutaryl-coenzyme A reductase inhibitors; Treatment outcome

MeSH Terms

Acute Coronary Syndrome
Angioplasty
Humans
Incidence
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention
Stents
Treatment Outcome

Figure

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  Fig. 1 Incidence of cardiac biomarker elevation after percutaneous coronary intervention. A: incidences of any CK-MB elevation (37.2% vs. 21.5%, p<0.001), >3 times elevation (6.6% vs. 2.1%, p=0.016), and >5 times elevation (4.1% vs. 1.3%, p=0.054) were higher in the control group than in the statin group. B: incidences of any troponin elevation (43.4% vs. 31.2%, p=0.006), >3 times elevation (24.0% vs. 15.2%, p=0.016), and >5 times elevation (13.6% vs. 8.4%, p=0.070) were higher in the control group than in the statin group.

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