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| Post-Hospital Discharge Treatment of Statin in Patients with Acute Myocardial Infarction: Is Statin Beneficial in Patient with LDL-cholesterol Lower Than 70 mg/dL? |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 한수경, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
Background: Intensive statin therapy in patients with acute myocardial infarction was strongly recommended. However, in case of patients who have low-density lipoprotein (LDL) level below 70 mg/dL, the long-term use of statin was questionable. The aim of this study was to identify whether statin therapy in low LDL level could affect long-term clinical outcome or not.
Methods: A total of 407 AMI patients (65.3± 13.2 years, 72.5% males) enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) between Nov. 2005 and Jan. 2008 who had LDL level below 70 mg/dL were included in the present study. The patients were divided into two groups whether prescribed statin at the time of discharge or not: group I (prescribed, n=251), and group II (Not prescribed, n=156).
Results: During the one-year follow-up, all cause of death or myocardial infarction (MI) occurred in 50 patients (12.3%). There were no significant differences in age (64.7±13.4 vs. 66.3±12.8 years, p=0.237), admission glucose (171.8±81.4 vs. 159.1±76.3 mg/dL, p=0.121), creatinine (1.31±1.31 vs. 1.39±1.54 mg/dL, p=0.541) level, and ejection fraction (EF) on periprocedural echocardiogram (54.7±43.5 vs. 50.5±13.0%, p=0.256). There were significant differences between two groups in the incidence of treated hyperlipidemia (14.5% vs. 7.1%, p=0.024), more hypertension (57.6% vs. 45.8%) and more diabetes (35.2% vs. 28.8%, p=0.185) without statistically differences. The incidence of high-sensitivity C-reactive protein level (hsCRP) above 2mg/dL (47.1% vs. 46.3%, p=0.888) was similar. By using multi-variate Cox regression analysis, which was adjusted with the parameters of post-discharge GRACE (The Global Registry of Acute Coronary Events) score and mentioned above, there were no significant differences in death or MI rates between two groups [hazard ratio (HR) = 1.70, 95% CI (confidential interval) 0.72-4.06, p=0.229], even in case of patients with hsCRP above 2 mg/dL, no significant differences also existed (HR 1.51, 95% CI 0.42-5.41, p=0.527).
Conclusion: Hospital discharge long-term statin therapy did not reduce death/MI at one year in AMI patients with LDL level below 70 mg/dL, even in patients with high hsCRP levels.
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