Benefit of early statin therapy in patients with acute MI
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
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.
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.
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.
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.
Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome.
LDL-C lowering with a statin reduces mortality risk and risk of cardiovascular events in primary care and in patients with ACS . 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.
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).
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).
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