Abstract 18565: Statin Utilization and Outcomes Among Patients With Coronary Artery Disease Undergoing Percutaneous or Surgical Revascularization

Abstract

Background: Patients undergoing coronary revascularization are at high risk for adverse health outcomes. Accordingly, current guidelines suggest high-intensity use of statin intervention therapy to help mitigate atherosclerotic risk. We analyzed outcomes of patients following coronary revascularization stratified by the level of statin intervention in a large, real-world integrated healthcare system. Methods: Patients were stratified by type of coronary revascularization (percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG)). Statin use was divided as: (1) no statin, (2) less than guideline-directed statin intensity (<GDSI), and GDSI. HRs and incidence rate per 1000-person years were assessed for secondary ASCVD outcomes (MI, ischemic stroke/TIA and all-cause death) in the population. Results: Over a mean follow up of about 5 years, a total of 33,513 patients underwent PCI and 12,436 underwent CABG. Over 35% of patients in both groups received either <GDSI or no statin therapy. Patients who underwent PCI and were given no statin treatment had higher incidence of MI (69 vs 23 per 1000PY), stroke (21 vs 10) and death (69 vs 30) than those on GDSI. Patients who underwent CABG and were given no statin treatment had higher incidence of MI (31 vs 15 per 1000PY), stroke (30 vs 13) and death (79 vs 20) than those on GDSI. Amongst both groups, adjusted analysis showed that patients receiving GDSI had significantly lower risk for all major adverse cardiovascular outcomes (Table). In particular, GDSI in patients undergoing PCI was associated with the most significant reduction in MI, with an HR of 0.42. Conclusions: Underuse of GDSI was highly prevalent in patients undergoing coronary vascularization, both for PCI and CABG, and this was associated with suboptimal outcomes. Further practical interventions should be studied to assure that patients are treated aggressively with guideline directed therapies to lower risk for adverse outcomes.