Korean J Med.  2004 Jun;66(6):576-585.

The prognostic significance of statin therapy in acute myocardial infarction patients with left ventricular dysfunction

• Hong YJ
• Jeong MH
• Lim JH
• Park HW
• Kim HG
• Park OY
• Kim JH
• Kim W
• Ahn YK
• Cho JG
• Suh SP
• Ahn BH
• Park JC
• Kim SH
• Kang JC

Abstract

BACKGROUND: Statins reduce mortality of patients with coronary artery disease. However, many trials have excluded patients with ischemic heart failure. Statins may have other beneficial effects besides cholesterol lowering, such as anti-inflammatory properties and improvement of endothelial function. The aim of this study was to determine the effects of statin therapy in acute myocardial infarction (AMI) patients with left ventricular (LV) dysfunction.
METHODS
We studied 202 patients with AMI with LV dysfunction [ejection fraction (EF) below 40%] between January 2001 and June 2002. The patients were divided into two groups: Group I (n=106, 60.8 +/- 10.3 years, male 71.7%) who were treated with simvastatin and Group II (n=96, 60.9 +/- 10.4 years, male 78.1%) who were not treated with simvastatin.
RESULTS
At six-month after percutaneous coronary intervention (PCI), LVEF was more improved in Group I than in Group II (30.8 +/- 10.0% to 42.4 +/- 10.7% vs 31.9% to 38.9%, p=0.042). The levels of total cholesterol, triglyceride and low density lipoprotein-cholesterol were more decreased and the level of high density lipoprotein-cholesterol was more increased in Group I than in Group II. The levels of C-reactive protein, fibrinogen, white blood cell and monocyte count were more decreased in Group I than in Group II. During one-year clinical follow-up, statin therapy was associated with a significant reduction in mortality (1.9% vs 7.5%, p=0.048), restenosis rate (25.7% vs 43.1%, p=0.033) and repeat PCI rate (25.7% vs 43.1%, p=0.033). The event-free survival rate was higher in Group I than in Group II (79.8% vs 57.0%, p=0.001).
CONCLUSION
Statin therapy improves LV systolic function and decreases mortality, restenosis and repeat PCI in the AMI with LV dysfunction.

Keyword

Statins; Myocardial Infarction; Heart failure; Cholesterol; Inflammation; Survival

MeSH Terms

C-Reactive Protein
Cholesterol
Coronary Artery Disease
Disease-Free Survival
Fibrinogen
Follow-Up Studies
Heart Failure
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Inflammation
Leukocytes
Male
Monocytes
Mortality
Myocardial Infarction*
Percutaneous Coronary Intervention
Simvastatin
Triglycerides
Ventricular Dysfunction, Left*
C-Reactive Protein
Cholesterol
Fibrinogen
Simvastatin