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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

Event : ESC Congress 2019

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

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:
Y.H. Kim1 , A.-Y. Her1 , M.H. 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 City - 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) ,

Topic(s):
Lipid-Lowering Agents

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 3255

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.

OutcomesCumulative Events at 2-year (%)Hazard Ratio (95% CI)p value
STEMINSTEMILog-rank
Propensity score matched patients
MACE532 (7.2)584 (8.1)0.0921.106 (0.984–1.244)0.092
All-cause death163 (2.2)224 (3.1)0.0011.386 (1.133–1.696)0.002
Cardiac death121 (1.5)148 (2.0)0.0881.232 (0.969–1.566)0.089
Re-MI117 (1.6)107 (1.5)0.5450.922 (0.710–1.199)0.545
Total revascularization291 (4.1)307 (4.4)0.4221.068 (0.910–1.254)0.423
TLR92 (1.3)89 (1.2)0.8800.978 (0.731–1.309)0.880
TVR173 (2.4)184 (2.6)0.4781.078 (0.876–1.327)0.478
Non-TVR123 (1.7)130 (1.9)0.5931.070 (0.836–1.369)0.539

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