Physicians' Academy for Cardiovascular Education

Benefit of early statin therapy in patients with acute MI

Literature - Lee KH et al, J Am Coll Cardiol 2011;58:1664–71

Benefit of Early Statin Therapy in Patients With Acute Myocardial Infarction Who Have Extremely Low Low-Density Lipoprotein Cholesterol


Ki Hong Lee, MD, Myung Ho Jeong, MD, PhD, Ha Mi Kim, RN, Youngkeun Ahn, MD, PhD, Jong Hyun Kim, MD, Shung Chull Chae, MD, PhD, Young Jo Kim, MD, PhD, Seung Ho Hur, MD, PhD, In Whan Seong, MD, PhD, Taek Jong Hong, MD, PhD,
Dong Hoon Choi, MD, PhD, Myeong Chan Cho, MD, PhD, Chong Jin Kim, MD, PhD, Ki Bae Seung, MD, PhD, Wook Sung Chung, MD, PhD, Yang Soo Jang, MD, PhD, Seung Woon Rha, MD, PhD, Jang Ho Bae, MD, PhD, Jeong Gwan Cho, MD, PhD,
Seung Jung Park, MD, PhD, for the KAMIR (Korea Acute Myocardial Infarction Registry)Investigators

J Am Coll Cardiol 2011;58:1664–71


Objectives

We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl.


Background

Intensive lipid-lowering therapy with a target LDL-C value <70 mg/dl is recommended in patients with very high cardiovascular risk. However, whether to use statin therapy in patients with baseline LDL-C levels below 70 mg/dl is controversial.


Methods

We analyzed 1,054 patients with AMI who had baseline LDL-C levels below 70 mg/dl and survived at discharge from the Korean Acute MI Registry between November 2005 and December 2007. They were divided into 2 groups according to the prescribing of statins at discharge (statin group n = 607; nonstatin group n = 447). The primary endpoint was the composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting.


Results

Statin therapy significantly reduced the risk of the composite primary endpoint (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.34 to 0.89; p = 0.015). Statin therapy reduced the risk of cardiac death (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031) and coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). However, there were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated percutaneous coronary intervention rate.


Conclusions

Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome.


Background

LDL-C lowering with a statin reduces mortality risk and risk of cardiovascular events in primary care and in patients with ACS [1]. Patients with ACS should be early and intensively treated with statin therapy, as lowering LDL-C concentrations has shown clinical benefits [2-4]. The ACC/AHA guidelines state that patients at very high risk should be treated to an LDL-C target < 0 mg/dl [5,6].
For patients with ACS with LDL-C levels below 70 mg/dl, the treatment choice is not clear. This study investigated whether statin treatment could be of benefit in patients with AMI with baseline LDL-C levels < 70 mg/dl.

The study population consisted 1,054 patients with AMI and LDL-C < 70 mg/dl from KAMIR (Korea Acute Myocardial Infarction Registry) from November 2005 to December 2007. Statin group n=607; nonstatin group n=447. The primary endpoint was a composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting.


Main results

During the 12-month follow-up period, a primary endpoint event occurred in 58 patients (14.5%) in the statin group and 57 patients (20.4%) in the nonstatin group (log-rank p=0.024).
The risk of the composite primary endpoint was significantly reduced with statin therapy (adjusted HR: 0.56; 95% CI 0.34-0.89, p=0.015). The risk of cardiac death was reduced (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031), as was the risk of coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). There were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated PCI rate.


Conclusion

In patients with AMI with LDL-C, 70 mg/dl, statin therapy improved clinical outcome and significantly reduced the risk of composite primary endpoint (by reducing risk of cardiac death and coronary revascularization).

References

1. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267–78.
2. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005;352:1425–35.
3. Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006;48:438–45.
4. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350:1495–504.
5. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2008;51:210–47.
6. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2007;50:e1–157.

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