Statin therapy is indicated after ST-segment elevation myocardial infarction (STEMI)
to reduce recurrent ischemic events, but approximately 6% of patients with STEMI do
not receive a statin prescription at discharge. This substudy aimed to define the
clinical outcomes and patient characteristics associated with statin nonprescription
after STEMI. We compared clinical, angiographic, and procedural characteristics and
in-hospital, 30-day, 1-year, 2-year, and 3-year outcomes in 3,512 patients discharged
after STEMI with and without (6%) statin prescriptions in the harmonizing outcomes
with revascularization and stents in acute myocardial infarction trial (www.clinicaltrials.gov, NCT00433966). Statin nonprescription was associated with female sex, nonwhite race, previous
bypass surgery, heart failure, renal impairment, anemia, thrombocytopenia, care in
the United States, lower prescription rates of antiplatelets and neurohormonal antagonists,
less percutaneous coronary intervention and stents, and, in 26% of cases, angiographically
normal or nonobstructed coronary arteries. At every time point of follow-up after
discharge, patients with no discharge statin prescription had significantly higher
rates of net adverse clinical events, major adverse cardiac events, major bleeding
unrelated to bypass surgery, and death. After multivariable adjustment, absence of
a discharge statin prescription independently predicted 3-year major adverse cardiac
event (hazard ratio 1.54, 95% confidence interval 1.15 to 2.07, p = 0.0037) and death
(hazard ratio 2.30, 95% confidence interval 1.41 to 3.77, p = 0.0009). In conclusion,
within the framework of this randomized trial of patients presenting with STEMI, approximately
6% of patients were discharged without statin therapy. Absence of a discharge statin
prescription after STEMI was an independent predictor of ischemic events including
death.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention.J Am Coll Cardiol. 2010; 56: 254-263
- The harmonizing outcomes with revascularization and stents in acute myocardial infarction (HORIZONS-AMI) trial: study design and rationale.Am Heart J. 2008; 156: 44-56
- Bivalirudin during primary PCI in acute myocardial infarction.N Engl J Med. 2008; 358: 2218-2230
- Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction.N Engl J Med. 2009; 360: 1946-1959
- Qualitative and quantitative angiography.in: Topol E.J. Textbook of Interventional Cardiology. WB Saunders, Philadelphia, PA1999: 725-747
- Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial.Lancet. 2009; 374: 1149-1159
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- Impact of in-hospital major bleeding on outcomes in acute coronary syndromes.Curr Opin Cardiol. 2012; 27: 669-674
- Collaborative overview of randomised trials of antiplatelet therapy–I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.BMJ. 1994; 308: 81-106
- Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation.N Engl J Med. 2005; 352: 1179-1189
- Beta blockade after myocardial infarction: systematic review and meta regression analysis.BMJ. 1999; 318: 1730-1737
- Ace inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials.Circulation. 1995; 92: 3132-3137
- The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and recurrent events trial investigators.N Engl J Med. 1996; 335: 1001-1009
- Comparison of outcomes in acute coronary syndrome in patients receiving statins within 24 hours of onset versus at later times.Am J Cardiol. 2004; 94: 1166-1168
- Modulation of arterial reactivity using amlodipine and atorvastatin measured by ultrasound examination (MARGAUX).Atherosclerosis. 2008; 197: 420-427
- Rapid effects on vascular function after initiation and withdrawal of atorvastatin in healthy, normocholesterolemic men.Am J Cardiol. 2001; 88: 1306-1307
- Acute effect of atorvastatin on coronary circulation measured by transthoracic doppler echocardiography in patients without coronary artery disease by angiography.Am J Cardiol. 2005; 96: 89-91
- Short-term treatment with atorvastatin reduces platelet CD40 ligand and thrombin generation in hypercholesterolemic patients.Circulation. 2005; 111: 412-419
- Atorvastatin, administered at the onset of reperfusion, and independent of lipid lowering, protects the myocardium by up-regulating a pro-survival pathway.J Am Coll Cardiol. 2003; 41: 508-515
- Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries.Am J Cardiol. 2005; 95: 261-263
- Long-term prognosis of patients presenting with ST-segment elevation myocardial infarction with no significant coronary artery disease (from the HORIZONS-AMI trial).Am J Cardiol. 2013; 111: 643-648
- Coronary plaque burden detected by multislice computed tomography after acute myocardial infarction with near-normal coronary arteries by angiography.Am J Cardiol. 2003; 92: 849-852
- In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.J Am Coll Cardiol. 2013; 62: 1748-1758
- Statin adherence and risk of accidents: a cautionary tale.Circulation. 2009; 119: 2051-2057
Article info
Publication history
Published online: February 03, 2014
Accepted:
January 8,
2014
Received in revised form:
January 8,
2014
Received:
November 22,
2013
Footnotes
The HORIZONS-AMI trial was sponsored by the Cardiovascular Research Foundation with research grant support from Boston Scientific, Natick, Massachusetts and The Medicines Company, Parsippany, New Jersey.
See page 1278 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
