Abstract
ObjectiveLarge randomized trials have failed to show a beneficial effect of statin treatment in chronic HF. The investigators tried to evaluate the long-term effects of statin therapy in patients with new onset heart failure (HF) following acute myocardial infarction (AMI).MethodsBetween January 2008 and December 2011, a total of 13,616 AMI patients were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR) which was a prospective, multi-center, nationwide, web-based database of AMI in Korea. From this database, we studied 1,055 patients with AMI who had newly developed severe acute HF [left ventricular ejection fraction ≤ 40%] and were discharged alive. The patients were divided into two groups, a statin group (n = 756) and a no-statin group (n = 299). We investigated the one-year major adverse cardiovascular events (MACEs), including all-cause mortality, MI, and any revascularization of each group. We then performed a propensity-score matched analysis.ResultsIn the original cohort, one-year MACEs were similar between the two groups (16.5% vs. 14.7% in the statin or no-statin groups; p = 0.47). Propensity-score matching yielded 256 pairs, and in that population we observed comparable results in terms of MACEs (18.0% vs. 12.5% in the statin or no-statin groups, p = 0.11) and mortality (5.1% vs. 3.5% in the statin or no-statin groups, p = 0.51). Cox-regression analysis revealed that statin therapy was not an independent predictor for occurrence of a MACE [Hazard ratio (HR) 1.11, 95% CI 0.79–1.57, p = 0.54] or all-cause mortality (HR 1.42, 95% CI 0.75–2.70, p = 0.28).ConclusionStatin therapy was not associated with a reduction in the long-term occurrence of MACEs or mortality in survivors of AMI with severe acute HF in this retrospective cohort study.
Highlights
The 3-hydroxy-3-methylglutaryl coenzyme-A inhibitors or statins are widely used, and statin therapy has been shown to reduce adverse cardiovascular (CV) events and all-cause mortality in atherosclerotic coronary artery disease [1,2]
One-year major adverse cardiac events (MACEs) were similar between the two groups (16.5% vs. 14.7% in the statin or no-statin groups; p = 0.47)
Cox-regression analysis revealed that statin therapy was not an independent predictor for occurrence of a MACE [Hazard ratio (HR) 1.11, 95% confidence intervals (CI) 0.79– 1.57, p = 0.54] or all-cause mortality (HR 1.42, 95% CI 0.75–2.70, p = 0.28)
Summary
The 3-hydroxy-3-methylglutaryl coenzyme-A inhibitors or statins are widely used, and statin therapy has been shown to reduce adverse cardiovascular (CV) events and all-cause mortality in atherosclerotic coronary artery disease [1,2]. Some clinical studies have shown that statin therapy is associated with improved outcomes in patients with chronic HF and that statin therapy reduces the development of HF after acute coronary syndrome [3,4,5,6], two large randomized clinical trials failed to demonstrate a beneficial effect of statin add-on therapy (rosuvastatin) in chronic HF patients who were medically well-controlled [7,8]. To address this issues, we performed an observational study using a nationwide registry to ascertain whether statin therapy improves long-term clinical outcomes, including major adverse cardiac events (MACEs) and mortality, in survivors from acute ischemic HF. We analyzed clinical outcomes of acute ischemic HF patients by intensity of statin dosage
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