Intensity of Statin Treatment in Korean Patients with Acute Myocardial Infarction and Very Low LDL Cholesterol

다국어 초록 (Multilingual Abstract)

Objective: Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL.
Methods: A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months.
Results: After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118).
Conclusion: More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.

참고문헌 (Reference)

1 Boekholdt SM, "Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials" 64 : 485-494, 2014

2 Normand ST, "Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores" 54 : 387-398, 2001

3 Rao AK, "Thrombolysis in Myocardial Infarction (TIMI) Trial--phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase" 11 : 1-11, 1988

4 Thygesen K, "Third universal definition of myocardial infarction" 126 : 2020-2035, 2012

5 Vaughan CJ, "The evolving role of statins in the management of atherosclerosis" 35 : 1-10, 2000

6 Mauri L, "Stent thrombosis in randomized clinical trials of drug-eluting stents" 356 : 1020-1029, 2007

7 "Statin dose comparison" 25 : 250801-, 2009

8 Liao JK, "Safety and efficacy of statins in Asians" 99 : 410-414, 2007

9 D'Agostino RB Jr, "Propensity score methods for bias reduction in the comparison of a treatment to a nonrandomized control group" 17 : 2265-2281, 1998

10 Granger CB, "Predictors of hospital mortality in the global registry of acute coronary events" 163 : 2345-2353, 2003

11 Austin PC, "Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies" 10 : 150-161, 2011

12 Kim JH, "Multicenter cohort study of acute myocardial infarction in Korea - Interim analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry -" 80 : 1427-1436, 2016

13 Cho KH, "Low-density lipoprotein cholesterol level in patients with acute myocardial infarction having percutaneous coronary intervention (the cholesterol paradox)" 106 : 1061-1068, 2010

14 Cannon CP, "Intensive versus moderate lipid lowering with statins after acute coronary syndromes" 350 : 1495-1504, 2004

15 Natsuaki M, "Intensity of statin therapy, achieved low-density lipoprotein cholesterol levels and cardiovascular outcomes in Japanese patients after coronary revascularization. Perspectives from the CREDO-Kyoto registry cohort-2" 76 : 1369-1379, 2012

16 Taguchi I, "High-Dose versus Low-Dose Pitavastatin in Japanese Patients with Stable Coronary Artery Disease (REAL-CAD): a randomized superiority trial" 137 : 1997-2009, 2018

17 Cannon CP, "Ezetimibe added to statin therapy after acute coronary syndromes" 372 : 2387-2397, 2015

18 Sabatine MS, "Evolocumab and clinical outcomes in patients with cardiovascular disease" 376 : 1713-1722, 2017

19 Hwang D, "Effects of statin intensity on clinical outcome in acute myocardial infarction patients" 82 : 1112-1120, 2018

20 Schwartz GG, "Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial" 285 : 1711-1718, 2001

21 Tsai TT, "Effect of statin use in patients with acute coronary syndromes and a serum low-density lipoprotein%3Cor=80 mg/dl" 96 : 1491-1493, 2005

22 Kim M, "Comparing high-intensity versus low-to moderate-intensity statin therapy in Korean patients with acute myocardial infarction" 3 : 97-104, 2014

23 Giugliano RP, "Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial" 390 : 1962-1971, 2017

24 Wang X, "Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis" 44 : 1833-1839, 2013

25 Piao ZH, "Benefits of statin therapy in patients with acute myocardial infarction with serum low-density lipoprotein cholesterol ≤ 50 mg/dl" 120 : 174-180, 2017

26 Lee KH, "Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low low-density lipoprotein cholesterol" 58 : 1664-1671, 2011

27 Sacco RL, "An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association" 44 : 2064-2089, 2013

28 Grundy SM, "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol:a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines" 73 : e285-e350, 2019

29 Catapano AL, "2016 ESC/EAS guidelines for the management of dyslipidaemias" 37 : 2999-3058, 2016

30 Levine GN, "2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" 58 : e44-e122, 2011