Current statin usage for patients with acute coronary syndrome undergoing percutaneous coronary intervention:
Mi-Jeong Kim1, Doo Soo Jeon, Hyeon-Cheol Gwon
1Cardiovascular Center, Incheon St. Mary's Hospital, The Catholic University, Incheon, Republic of Korea.
Insights
High-dose statin use is low in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI), especially for unstable angina/non-ST-elevated myocardial infarction. Real-world practice needs to align with evidence-based guidelines for optimal patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Practice Research
Background:
- High-dose statin therapy is proven to improve outcomes in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).
- Real-world data on statin usage patterns in this patient population are limited.
Purpose of the Study:
- To investigate the patterns of high-dose statin usage in patients with ACS following PCI.
- To identify clinical factors influencing statin prescription patterns in ACS patients undergoing PCI.
Main Methods:
- A multicenter prospective registry of 3362 ACS patients who underwent PCI was analyzed.
- High-dose statin treatment was defined as atorvastatin ≥40 mg or rosuvastatin ≥20 mg daily.
- Statin usage patterns were assessed for 30 days post-PCI.
Main Results:
- Pre-PCI, high-dose statins were given to 13.7% (UA/NSTEMI) and 19.6% (STEMI) of patients.
- Post-PCI, 14.2% received high-dose statins, while 16.4% received none.
- STEMI, high cholesterol, and current smoking were linked to high-dose statin use; absence of hypercholesterolemia predicted non-use.
Conclusions:
- High-dose statin therapy is underutilized in real-world clinical practice for ACS patients undergoing PCI, particularly for UA/NSTEMI.
- Clinical practice should be aligned with evidence-based guidelines to improve statin adherence and patient outcomes.
Background:
Although high-dose statin therapy has been reported to improve outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), patterns of statin usage for such patients have not been reported in real-world clinical practice.
Hypothesis:
Some clinical factors would affect the pattern of statin usage in patients with ACS.
Methods:
In the multicenter prospective registry, 3362 patients with ACS who underwent PCI were analyzed. High-dose statin treatment was defined as atorvastatin ≥40 mg or rosuvastatin ≥20 mg per day. The patterns of statin usage were investigated for 30 days after the index PCI.
Results:
High-dose statins were administered prior to PCI to 13.7% and 19.6% of patients with unstable angina/non-ST-elevated myocardial infarction (UA/NSTEMI) and ST-elevated myocardial infarction (STEMI), respectively (P < 0.001). After PCI, 476 (14.2%) patients were maintained on high-dose statins, and 550 (16.4%) patients received no statins. Independent factors associated with high-dose statin usage after PCI were STEMI (odds ratio [OR]: 1.704, 95% confidence interval [CI]: 1.321-2.197, P < 0.001), high total cholesterol level (OR: 1.445, 95% CI: 1.136-1.837, P = 0.003), and current smoker (OR: 1.556, 95% CI: 1.206-2.008, P < 0.011). The absence of hypercholesterolemia was an independent factor determining the nonuse of statins (OR: 0.229, 95% CI: 0.148-0.353, P < 0.001).
Conclusions:
In real-world clinical practice, high-dose statin treatment is being underused despite extensive evidence for patients with ACS undergoing PCI, particularly in UA/NSTEMI. Efforts are needed to ensure that clinical practice complies with evidence-based guidelines.
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