J Lipid Atheroscler.  2019 Sep;8(2):208-220. 10.12997/jla.2019.8.2.208.

Intensity of Statin Treatment in Korean Patients with Acute Myocardial Infarction and Very Low LDL Cholesterol

• Sim DS
• Jeong MH
• Kim HS
• Gwon HC
• Seung KB
• Rha SW
• Chae SC
• Kim CJ
• Cha KS
• Park JS
• Yoon JH
• Chae JK
• Joo SJ
• Choi DJ
• Hur SH
• Seong IW
• Cho MC
• Kim DI
• Oh SK
• Ahn TH
• Hwang JY
• on behalf of the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) registry investigators

• KMID: 2458386
• DOI: http://doi.org/10.12997/jla.2019.8.2.208

Abstract

OBJECTIVE
Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL.
METHODS
A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months.
RESULTS
After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118).
CONCLUSION
More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.

Keyword

Cholesterol; Myocardial infarction; Statins

MeSH Terms

Cholesterol
Cholesterol, LDL*
Death
Hemorrhage
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Incidence
Korea
Lipoproteins
Myocardial Infarction*
Stroke
Cholesterol
Cholesterol, LDL
Lipoproteins

Figure

• 

  Fig. 1 The study flow diagram of the patients. KAMIR-NIH, Korea Acute Myocardial Infarction Registry-National Institute of Health; LDL, low-density lipoprotein.

• 

  Fig. 2 Changes in levels of LDL cholesterol (A) and hs-CRP (B) from baseline to 12 months in the propensity-matched cohort. Median (interquartile range) values in the two groups. The p-values are for interaction effects between treatment group and time. hs-CRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein.

• 

  Fig. 3 Cumulative MACCE at 12 months with adjustment using propensity score matching. MACCE; major adverse cardiac and cerebrovascular event.

• 

  Fig. 4 Subgroup analysis for MACCE at 12 months in the propensity-matched cohort. CI, confidence interval; hs-CRP, high-sensitivity C-reactive protein; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LVEF, left ventricular ejection fraction; MACCE, major adverse cardiac and cerebrovascular event; MI, myocardial infarction; GRACE, Global Registry of Acute Coronary Event.

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