Effect of previous statin therapy in patients with acute coronary syndrome and percutaneous coronary intervention
Kyeong Ho Yun1, Ik-Sang Shin, Seoung-Nam Shin
1Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
Insights
Previous statin therapy before acute coronary syndrome (ACS) significantly reduces periprocedural myocardial infarction (MI) and in-hospital major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). This finding highlights the benefit of pre-ACS statin use in improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Statin therapy post-percutaneous coronary intervention (PCI) is linked to reduced major adverse cardiovascular events (MACE).
- The benefit of statin therapy initiated before acute coronary syndrome (ACS) remains less clear.
- This study investigates the impact of pre-ACS statin initiation on outcomes following PCI.
Purpose of the Study:
- To evaluate the effect of previous statin therapy, started at least one month before PCI, on patients with ACS undergoing early invasive strategies.
- To compare the incidence of periprocedural myocardial infarction (MI) and in-hospital MACE between statin-treated and statin-naive ACS patients.
Main Methods:
- A cohort of 479 consecutive ACS patients undergoing PCI were stratified into two groups: previous statin-treated (n=237) and statin-naive (n=242).
- Outcomes assessed included periprocedural MI and in-hospital MACE.
- Multivariate analysis was used to identify independent predictors of in-hospital MACE.
Main Results:
- The statin group exhibited lower incidences of Braunwald class III angina and MI presentation.
- The slow/no reflow phenomenon was more frequent in the statin-naive control group.
- Periprocedural MI occurred significantly less often in the statin group (2.1% vs. 6.6%, p=0.016).
- No prior statin use, procedural complication, stent overlap, and old age were independent predictors for in-hospital MACE.
Conclusions:
- Previous statin therapy before ACS is associated with a milder clinical presentation.
- Pre-ACS statin use significantly reduces periprocedural MI and in-hospital MACE following early invasive PCI strategies.
- The beneficial effect of statins is primarily attributed to the reduction in periprocedural MI.
Background And Objectives:
Statin therapy after percutaneous coronary intervention (PCI) has been associated with reduced major adverse cardiovascular events (MACE). However, it has been less clear as to whether statin therapy before acute coronary syndrome (ACS) is beneficial. We studied the effect of previous statin therapy, initiated ≥1 month before PCI, on the outcome of patients with ACS who had undergone early invasive strategies.
Subjects And Methods:
We stratified 479 consecutive patients with ACS who had undergone PCI, according to preprocedural statin administration as follows: previous statin-treated patients (statin group, n=237) and statin-naive patients (control group, n=242). The incidence of periprocedural myocardial infarction (MI) and in-hospital MACE was assessed.
Results:
The incidence of Braunwald class III angina and MI presentation were significantly lower in the statin group than in the control group. Angiographic and procedural characteristics were similar between the two groups; however, slow/no reflow phenomenon occurred more frequently in the control group. After PCI, the incidence of periprocedural MI was higher in the control group than in the statin group (6.6% vs. 2.1%, p=0.016). Multivariate analysis revealed that no prior use of statin {odds ratio (OR)=2.8; 95% confidence interval (CI)=1.1-7.2; p=0.038), procedural complication (OR=4.0; 95% CI=1.5-10.5; p=0.004), stent overlap (OR=4.7; 95% CI=1.3-16.4; p=0.015), and old age (OR=3.2; 95% CI=1.2-8.0; p=0.016) were independent predictors for in-hospital MACE.
Conclusion:
Previous statin therapy before ACS was associated with milder clinical presentation and lower incidence of in-hospital MACE after early invasive strategies. The beneficial outcome is attributable to a significant reduction in periprocedural MI after PCI.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Atherosclerosis III: Management
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care