PDF
ePub
Citation
Print
Abstract
The purpose of the present study was to assess the clinical effects of statin on major adverse cardiac events (MACE) at the time of discharge in elderly patients with acute myocardial infarction (AMI) and with left ventricular dysfunction (LVD) who underwent percutaneous coronary intervention (PCI). The study was retrospective. One hundred seventy-nine elderly patients (≥70 year-old) with AMI with LVD (ejection fraction≤50%) who underwent PCI were analyzed out of AMI patients between 2006 and 2008. The patients were divided into two groups: Group I (n=137, 77.0±5.3 years, 81 males), who received statin before discharge, and Group II (n=42, 78.3±5.9 years, 22 males), who did not receive any statin. We performed a 6-month clinical follow-up after discharge. There were no significant differences in age, sex ratio, history of ischemic heart disease, blood pressure, heart rate on admission, ejection fraction, or prevalence of diabetes, hypertension, or dyslipidemia. According to the multiple logistic regression analysis, age was an independent predictor (p=0.003) and statin use significantly reduced 6-month MACE (p=0.037, OR=0.328, 95% CI: 0.115~0.933). No other factors were independent predictors of 6-month MACE. Statin therapy improves clinical outcomes in elderly AMI patients with LVD who undergo PCI.
Figures and Tables
Table 1
Baseline clinical characteristics
IHD, ischemic heart disease; LVEF, left ventricular ejection fraction; CK-MB, creatine kinase-MB; Tn-I, troponin-I; hsCRP, high sensitivity C-reactive peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; HDL-cholesterol, high density lipoprotein-cholesterol; LDL-cholesterol, low density lipoprotein (LDL)-cholesterol; ACE, Agiotensin Converting Enzyme; ARB, Angiotensin II Receptor blocker.
Table 2
Comparison of clinical characteristics according to the use of statin at the time of discharge
IHD, ischemic heart disease; LVEF, left ventricular ejection fraction; CK-MB, creatine kinase-MB; Tn-I, troponin-I; hsCRP, High sensitivity C-reactive peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; HDL-cholesterol, high density lipoprotein-cholesterol; LDL-cholesterol, low density lipoprotein (LDL)-cholesterol; ACE, Agiotensin Converting Enzyme; ARB, Angiotensin II Receptor blocker; PCI, percutaneous coronary intervention; MI, myocardial infarction; CABG, coronary artery bypass graft surgery.
References
1. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994. 344:1383–1389. [see comment].
2. Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002. 360:7–22.
3. Okazaki S, Yokoyama T, Miyauchi K, Shimada K, Kurata T, Sato H, et al. Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study. Circulation. 2004. 110:1061–1068.
4. Foody JM, Shah R, Galusha D, Masoudi FA, Havranek EP, Krumholz HM. Statins and mortality among elderly patients hospitalized with heart failure. Circulation. 2006. 113:1086–1082.
5. Mozaffarian D, Nye R, Levy WC. Statin therapy is associated with lower mortality among patients with severe heart failure. Am J Cardiol. 2004. 93:1124–1129.
6. Briel M, Schwartz GG, Thompson PL, de Lemos JA, Blazing MA, van Es GA, et al. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials. JAMA. 2006. 295:2046–2056. [see comment].
7. Liao JK. Beyond lipid lowering: the role of statins in vascular protection. Int J Cardiol. 2002. 86:5–18.
8. Tousoulis D, Charakida M, Stefanadi E, Siasos G, Latsios G, Stefanadis C. Statins in heart failure. Beyond the lipid lowering effect. Int J Cardiol. 2007. 115:144–150.
9. Waters DD, Ku I. Early statin therapy in acute coronary syndromes: the successful cycle of evidence, guidelines, and implementation. J Am Coll Cardiol. 2009. 54:1434–1437.
10. Katayama N, Nakao K, Horiuchi K, Ogawa H, Honda T. Early initiation of statin therapy in patients with acute myocardial infarction after successful percutaneous coronary intervention. J Cardiol. 2004. 44:131–140.
11. Kadota S, Matsuda M, Izuhara M, Baba O, Moriwaki S, Shioji K, et al. Long-term effects of early statin therapy for patients with acute myocardial infarction treated with stent implantation. J Cardiol. 2008. 51:171–178.
12. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and recurrent events trial investigators. N Engl J Med. 1996. 335:1001–1009. [see comment].
13. Raina A, Pickering T, Shimbo D. Statin use in heart failure: a cause for concern? Am Heart J. 2006. 152:39–49.
14. Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II. Lancet. 2000. 355:1582–1587.
15. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999. 354:447–455.
16. Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, et al. Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005. 294:2437–2445.
17. Hong YJ, Jeong MH, Lim JH, Park HW, Kim HG, Park OY, et al. The prognostic significance of statin therapy in acute myocardial infarction patients with left ventricular dysfunction. Korean J Med. 2004. 66:576–585.
18. Horwich TB, MacLellan WR, Fonarow GC. Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure. J Am Coll Cardiol. 2004. 43:642–648.
19. Hong YJ, Jeong MH, Hwang SH, Yun NS, Lee SR, Hong SN, et al. Effect of combination therapy with simvastatin and carvedilol in patients with left ventricular dysfunction complicated with acute myocardial infarction who underwent percutaneous coronary intervention. Circ J. 2006. 70:1269–1274.
20. Hong YJ, Jeong MH, Lim JH, Park HW, Kim HG, Park OY, et al. The prognostic significance of statin therapy in acute myocardial infarction patients underwent percutaneous coronary intervention. Korean J Med. 2003. 65:426–435.
21. Pyun WB. Are statins beneficial for patients with heart failure? Korean Circ J. 2008. 38:185–190.
22. Shin HH, Kim KB, Kang JC, Son MS, Kim JH, Kim JS, et al. Korean multicenter clinical trial of simvastatin (KS-1 study). Korean J Med. 1999. 57:906–915.
23. Ryan TJ, Bauman WB, Kennedy JW, Kereiakes DJ, King SB 3rd, McCallister BD, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American heart association/American college of cardiology task force on assessment of diagnostic and therapeutic cardiovascular procedures (committee on percutaneous transluminal coronary angioplasty). Circulation. 1993. 88:2987–3007.
24. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. A report of the American college of cardiology/American heart association task force on practice guidelines (committee on coronary angiography). Developed in collaboration with the society for cardiac angiography and interventions. J Am Coll Cardiol. 1999. 33:1756–1824.
XML Download