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ȣ - 540895 130 |
| Prognostic value of lipid-lowering medications by level of NT-proBNP for patients with baseline lower LDL cholesterol after acute myocardial infarction from the Korea Acute Myocardial Infarction Registry |
| 경북대학교병원 순환기 내과¹ , 영남대학교 순환기 내과²,전남대학교 순환기 내과³ , 대구가톨릭대학교 순환기 내과⁴ , 계명대학교 순환기 내과5 , 충남대학교 순환기 내과6 , 부산대학교 순환기 내과7 , 충북대학교 순환기 내과8 ,경희대학교 동서 신의학 병원9 |
| 이장훈¹, 채성철¹ , 박선희¹ , 강정규¹ , 김나영¹ , 양동헌¹ , 박헌식¹ , 조용근¹ , 전재은¹ , 박의현 ¹ , 김영조² , 정명호³ , 김기식⁴ ,허승호5 ,성인환6 , 홍택종7 , 조명찬8 , 김종진9 |
Background: There are conflicting reports on the role of statin in patients with lower low-density lipoprotein cholesterol (LDL-C) at baseline in patients with acute myocardial infarction (AMI). We investigated whether plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) could be used to identify the patients who can get the benefit from the statin therapy. Methods: Between November 2005 and January 2008, 1,625 statin-naive patients (1,207 men; mean age = 64.5 ± 12.5 years-old) with a LDL-C level of 105 mg/dL or less were selected from the Korea AMI registry. Plasma NT-proBNP levels were obtained at the time of admission. The MACE was defined as a composite of death, non-fatal MI, and revascularizations. Results: The statins were used in 70.3% of patients with low LDL-C levels after AMI. The mean LDL-C level was 81.6 ± 17.5 mg/dL and the mean NT-proBNP levels were 3335.2 ± 7279.3 pg/mL. Patients receiving statins were younger with fewer in Killip class II-IV, fewer renal dysfunction, fewer cardiogenic shock, more with a history of dyslipidemia, more with an smokers, more with an ST elevation MI, higher body mass index, higher systolic and diastolic blood pressure, higher LDL-C levels, lower NT-proBNP levels, more on beta-blockers and angiotensin converting enzyme inhibitors use. Percutaneous coronary intervention was more frequently performed in patients receiving statins. In Cox proportional-hazards model, the 12-month MACE (16.3% versus 20.7%; crude hazard ratio [HR] 0.745, 95% confidence interval [CI] 0.585–0.950; p=0.018) and mortality (7.1% versus 14.7%; crude HR 0.462, 95% CI 0.336–0.636; p<0.001) were significantly lower in statin patients compared with no-statin patients. Propensity scores (PS) for statin use was calculated for each of the patients, and were used to match 410 patients not receiving statin with 410 patients receiving statin. During the follow-up, 132 (16.1%) MACEs and 79 (9.6%) deaths from any cause occurred in the matched cohort. In Cox proportional-hazards model, 12-month mortality was significantly lower in statin patients compared with no statin patients (7.3% versus 12.0%; HR 0.602, 95%CI 0.382–0.949; p=0.029). Statins therapy for patients with the highest tertile of NT-proBNP (> 1,932 pg/mL) showed a trend toward lower 12-month mortality (HR 0.639, 95% CI 0.381-1.071, p=0.089) than patients in the other tertiles. Conclusions: In the PS matched analysis, statins therapy showed beneficial effect for reducing 12-month mortality in post-MI patients with baseline low LDL-C levels, particularly in those with higher plasma NT-proBNP levels.
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