Coronary Artery DiseaseInfluence of High-Dose Highly Efficient Statins on Short-Term Mortality in Patients Undergoing Percutaneous Coronary Intervention With Stenting for Acute Coronary Syndromes
Section snippets
Methods
In total, 1,528 consecutive patients, who underwent PCI for ACS, were included in a prospective registry from January 2003 to January 2011. Eighty-one patients (52.4%) had an ST elevation myocardial infarction (STEMI) and 727 (47.6%) had a non-STEMI at presentation. In post hoc analysis, cardiovascular risk factors, co-morbidities, and basal circulating lipid variables (total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides) at the time of the index event were
Results
Nine hundred twenty-six patients (60.6%) received high-dose atorvastatin (91.9%) or rosuvastatin (8.1%) and 602 patients (39.4%) received low-dose statin therapy with lower doses of atorvastatin, rosuvastatin, or different statins, or were not on statins at discharge due to normal cholesterol levels. Their baseline mean plasma levels of lipid variables are listed in Table 1. Sixty-six patients (7.1%) with high-dose statins and 44 patients (9.1%) with low-dose statins or without statin (p =
Discussion
In this post hoc analysis of a prospective registry, we were able to demonstrate that high-dose highly effective statins can reduce short-term all-cause mortality in patients with ACS treated with PCI plus stent implantation. This benefit was especially seen in patients with diabetes, renal dysfunction, and STEMI at presentation.
The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study4 and the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (19)
Outcome of Carotid Artery Endarterectomy in Statin Users versus Statin-Naïve Patients: A Systematic Review and Meta-Analysis
2018, World NeurosurgeryCitation Excerpt :There is substantial evidence from randomized data that use of statins before major vascular operations is associated with a 2- to 3-fold reduction in the rate of the combined cardiovascular end point of myocardial infarction (MI), ischemic stroke, unstable angina, and death.10,11 Similarly, randomized control trials (RCTs) on the preoperative use of statins before percutaneous coronary interventions showed a significant improvement of periprocedural outcomes.12-14 However, high quality studies, specifically designed for patients undergoing CEA are lacking.
Usefulness of Elevated Levels of Growth Differentiation Factor-15 to Classify Patients With Acute Coronary Syndrome Having Percutaneous Coronary Intervention Who Would Benefit from High-Dose Statin Therapy
2017, American Journal of CardiologyCitation Excerpt :High-dose, highly efficient statins reduce the progression of plaque volume as measured by intravascular ultrasound23–25 and can change plaque composition and morphology as shown with coronary computed tomography angiography in patients with ACS.26 A recent publication of our department demonstrated that high-dose, highly efficient statins can reduce short-term all-cause mortality compared with low-dose statins or no statin therapy in patients with ACS treated with PCI, especially in high-risk patients with diabetes mellitus and impaired renal function.11 This implicates that high-dose statins are more effective in high-risk patients and obtaining GDF-15 may help identify these patients.
Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment
2017, Preventive Medicine ReportsCitation Excerpt :Statins, widely used to lower cholesterol levels in primary and secondary prevention of CVD (Zhou and Liao, 2010), have an anti-thrombotic effect and are also often a part of secondary prevention of ACS. While their short-term benefits are unclear (Vale et al., 2014), several randomized controlled trials (RCTs), clinical observational studies, and meta-analyses have shown that statin treatment, in particular high-dose intensive treatment, improves long-term (months to years) outcomes in post-ACS patients reducing risk for death and/or cardiovascular events compared to lower-intensity treatments (Bavry et al., 2007; Cannon et al., 2006; Cholesterol Treatment Trialists et al., 2010; Farnier, 2008; Hulten et al., 2006; Josan et al., 2008), (Kasai et al., 2007a; Kasai et al., 2007b; Tentzeris et al., 2014). However, large, long-term, observational studies addressing their effect on risk of cardiovascular and non-cardiovascular morbidity and mortality in a clinical setting over time are warranted.
Effect of statins on early and late clinical outcomes of carotid endarterectomy and the rate of post-carotid endarterectomy restenosis
2015, Journal of the American College of SurgeonsCitation Excerpt :As a result, many patients with peripheral vascular disease are placed on statins, both for the lipid lowering effects of the drug and its above-mentioned pleiotropic effects.13 The effects of periprocedural statin administration have been studied in the treatment of coronary artery disease and acute coronary syndrome, but the results have been inconsistent, with some studies demonstrating reduced perioperative and late mortality,14 while others show no significant benefit of statin administration.15,16 Recently published literature has demonstrated that the perioperative use of statins in patients undergoing major vascular surgery is associated with reductions in both 30-day and 5-year mortality,17-19 as well as a reduction in major adverse cardiovascular events.20
This work was supported by the Association for the Promotion of Scientific Research in Arteriosclerosis, Thrombosis and Vascular Biology (ATVB), Vienna, Austria.
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