Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naïve Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
- Author:
Min Chul KIM
1
;
Youngkeun AHN
;
Jae Yeong CHO
;
Ki Hong LEE
;
Doo Sun SIM
;
Nam Sik YOON
;
Hyun Ju YOON
;
Kye Hun KIM
;
Young Joon HONG
;
Hyung Wook PARK
;
Ju Han KIM
;
Myung Ho JEONG
;
Jeong Gwan CHO
;
Jong Chun PARK
;
Kiyuk CHANG
;
Ki Bae SEUNG
Author Information
- Publication Type:Original Article
- Keywords: Myocardial infarction; Hydroxymethylglutaryl-CoA reductase inhibitors; Percutaneous coronary intervention
- MeSH: Bias (Epidemiology); Consensus; Death; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Incidence; Myocardial Infarction; Percutaneous Coronary Intervention
- From:Korean Circulation Journal 2019;49(5):419-433
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation. METHODS: A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24–48 hours) and group 3 (≥48 hours). We also made 3 stratified models to reduce bias: model 1 (<24 hours vs. ≥24 hours), model 2 (<48 hours vs. ≥48 hours) and model 3 (<24 hours vs. 24–48 hours). The endpoint was major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction and target-vessel revascularization) during median 3.8 years. RESULTS: During follow-up, incidence of MACE was lower in early statin group in both model 1 (14.3% vs. 18.4%, hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66–0.91; p=0.002) and model 2 (14.6% vs. 19.7%, HR, 0.81; 95% CI, 0.67–0.97; p=0.022). After propensity-score matching, results remained unaltered. Statin initiation <24 hours reduced MACE compared to statin initiation ≥24 hours in model 1. Statin initiation <48 hours also reduced MACE compared to statin initiation later in model 2. However, there was no difference in incidence of MACE between statin initiation <24 hours and 24–48 hours) in model 3. CONCLUSIONS: Early statin therapy within 48 hours after admission in statin-naïve patients with AMI reduced long-term clinical outcomes compared with statin initiation later. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682
