Prognostic Interactions between Statins and In-Hospital Revascularisation on the Outcome of Acute Coronary Syndrome

Abstract

To examine if the prognostic benefit of in-hospital revascularisation on survival among patients with acute coronary syndrome (ACS) was influenced by the use of statins at the initial hospital discharge. All ACS survivors discharged from Dunedin and Invercargill coronary care units between the years 2000 and 2002 were included. Of the 1057 hospital survivors with ACS (age 64.9+/-12.6 years, 63% male), 481 (45.5%) had in-hospital revascularisation (CABG in 123 patients and PCI in 377, including 19 with both procedures). Statins were prescribed at discharge in 47% of patients without and 73% of patients with revascularisation. Revascularisation was associated with lower mortality up to 5 years of follow-up (hazard ratio 0.29, 95% confidence interval 0.20-0.42). After adjusting for baseline differences and the use of statins, the hazard ratio was 0.39 (95% confidence interval 0.27-0.58). While the use of statins was a predictor for long-term survival (p<0.001), no significant interaction was found between the use of statins and in-hospital revascularisation in predicting survival. Both in-hospital revascularisation and the use of statins at hospital discharge independently improved outcome over a follow-up period of 2-5 years. There was no prognostic interaction detected between these two beneficial therapies.