Abstract P147: Statin Therapy is Associated With a Lower Risk of Death in Patients Post Myocardial Infarction

Abstract

Introduction: The use of statins after acute myocardial infarction (MI) has been shown to reduce the risk of recurrent MI and mortality. We examined the association between statin therapy and the risk of 1 year mortality after MI hospitalization. Methods: Data from the Veterans Health Administration was used to create a national sample of Veterans hospitalized for their first MI event between 2002 and 2015. Veterans with prevalent heart failure, stroke, or cancer diagnoses at the time of discharge for the index MI and prolonged hospitalization (greater than 30 days) were excluded. The statin therapy group was defined as Veterans having any statin prescription at the time of discharge. The primary outcome was all-cause mortality obtained from the National Death Index. We fitted a Cox regression model adjusted for age, length of hospital stay, peak cardiac troponin I ratio (the ratio of the peak measurement to the reference upper limit of normal for the assay) during hospitalization, statin use before admission, beta blocker prescription at discharge, liver disease, peripheral arterial disease, estimated glomerular filtration rate, high-density lipoprotein and total cholesterol levels. Billing codes were used to define exclusion criteria and co-morbidities. Results: Among 16,263 Veterans hospitalized for MI, mean age was 62 years and 98% were men. During 350 days mean follow up, 966 deaths occurred. In the statin therapy group 709/13,334 (5.3%) of Veterans died compared to 257/2,929 (8.8%) of Veterans without statin therapy. In an age-adjusted model, 1-year mortality was 35% lower (HR 0.65, 95%CI 0.56 - 0.75) for patients that were prescribed a statin at discharge compared to Veterans who did not receive a statin at discharge. In a multivariable model we observed a 27% (HR 0.73, 95% CI 0.63 - 0.85) lower risk of death for users of statin therapy compared to non-users (Figure). Conclusions: Statin therapy prescribed after a first MI event may reduce the 1 year risk of all-cause mortality.