Effect of prior statin treatment on the achievement of <55 mg/dL LDL cholesterol threshold in acute coronary syndrome patients undergoing percutaneous coronary intervention

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndrome (ACS) patients are associated with a higher risk of adverse cardiac events after percutaneous coronary intervention (PCI). A lower threshold level of low density cholesterol (LDL), less than 50 mg/dL, as recommended by most recent guidelines, has been associated with a lower risk of such events. An early and more pronounced achievement of such target LDL level could confer benefit to this high risk patient category. It is not known whether prior treatment with statins might have such beneficial effect in patients admitted with acute coronary syndromes undergoing PCI. Purpose To study the role of prior statin use in patients admitted with ACS and treated with PCI regarding the achievement of target LDL threshold. Methods We prospectively enrolled 400 consecutive ACS patients who underwent PCI treatment in our hospital. We collected peri- and postprocedural clinical and laboratory data; all patients were followed up and were asked to have their lipid profile measured at 1 month after discharge. Patients were divided in 2 groups: patients who were already on statin treatment on admission (group 1) and those who were not (group 2). Primary endpoint was achievement of target LDL threshold in accordance with current ESC guidelines 1 month after discharge, and secondary endpoint was in-hospital and 30-day occurrence of major adverse events (death, nonfatal myocardial infarction and re-hospitalization). Results Out of 400 patients, 105 of them composed group 1 and 295 patients composed group 2. Mean age was 64.96 +/- 10.26 years. 74.8% were males. 94.8% suffered from arterial hypertension, 41% from diabetes and 56.3% were active smokers. On admission, mean LDL level was 118.15 +/- 42.67 mg/dL in group 1 and 141.66 +/- 44.14 mg/dL in group (p=<0.05). 399 (99.7%) of the patients were discharged on a high intensity dose statin. 30 day clinical follow up was completed in all (n=400) patients and lipid profile was acquired from 379 (94%) patients. Mean LDL level was 83.2 +/- 31.2 mg/dL in group 1 and 86.56 +/- 86.56 mg/dL in group 2. The threshold of <55 mg/dL of target LDL, was achieved in 16.2% of the patients in group 1 and in 10.2% in group 2 (p=0.1). There was no in-hospital death in both groups. 1 patient in each group suffered periprocedural myocardial infarction. At 30-day follow up, secondary endpoint occurred in 15 patients (3.8%) in total cohort. 5 (4.8%) in first group (a composite of 2 deaths and 3 rehospitalizations) and in 10 (3.4%) in second group (a composite of 4 deaths and 6 rehospitalizations). Conclusion In patients with acute coronary syndrome who are treated with PCI, prior treatment with statin, despite a numerically more favorable outcome, has no statistically significant impact on achievement of LDL target threshold in accordance with current guidelines or in in-hospital and 30-day MACE occurrence.