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Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation

Session Poster Session 6

Speaker Ae-Young Her

Congress : ESC Congress 2019

  • Topic : cardiovascular pharmacology
  • Sub-topic : Lipid-Lowering Agents
  • Session type : Poster Session
  • FP Number : P5362

Authors : YH Kim (Chuncheon,KR), A-Y Her (Chuncheon,KR), MH Jeong (Gwangju,KR), B-K Kim (Seoul,KR), S-Y Lee (Gunpo,KR), S-J Hong (Seoul,KR), D-H Shin (Seoul,KR), C-M Ahn (Seoul,KR), J-S Kim (Seoul,KR), Y-G Ko (Seoul,KR), D Choi (Seoul,KR), M-K Hong (Seoul,KR), Y Jang (Seoul,KR)

Authors:
YH Kim1 , A-Y Her1 , MH Jeong2 , B-K Kim3 , S-Y Lee4 , S-J Hong3 , D-H Shin3 , C-M Ahn3 , J-S Kim3 , Y-G Ko3 , D Choi3 , M-K Hong3 , Y Jang3 , 1Kangwon National University School of Medicine - Chuncheon - Korea (Republic of) , 2Chonnam National University Hospital, Department of Cardiology - Gwangju - Korea (Republic of) , 3Severance Cardiovascular Hospital, Division of Cardiology, Yonsei University College of Medicine - Seoul - Korea (Republic of) , 4Sanbon Hospital, Wonkwang University College of Medicine, Department of Cardiology - Gunpo - Korea (Republic of) ,

Citation:

Background: Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI).

Purpose: The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES.

Methods: Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n = 15002) and the NSTEMI group (n = 11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period.

Results: After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n = 15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p = 0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1).

Conclusion: The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.

Cumulative Events at 2-year (%)

Outcomes

STEMI

NSTEMI

Log-rank

Hazard Ratio (95% CI)

p value

Propensity score matched Patients

MACE

532 (7.2)

584 (8.1)

0.092

1.106 (0.984 - 1.244)

0.092

All-cause death

163 (2.2)

224 (3.1)

0.001

1.386 (1.133 - 1.696)

0.002

Cardiac death

121 (1.5)

148 (2.0)

0.088

1.232 (0.969 - 1.566)

0.089

Re-MI

117 (1.6)

107 (1.5)

0.545

0.922 (0.710 - 1.199)

0.545

Total revascularization

291 (4.1)

307 (4.4)

0.422

1.068 (0.910 - 1.254)

0.423

TLR

92 (1.3)

89 (1.2)

0.880

0.978 (0.731 - 1.309)

0.880

TVR

173 (2.4)

184 (2.6)

0.478

1.078 (0.876 - 1.327)

0.478

Non-TVR

123 (1.7)

130 (1.9)

0.593

1.070 (0.836 - 1.369)

0.539



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