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ȣ - 540899 55 |
| Efficacy of statins in patients with acute heart failure 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 |
| 김나영¹, 채성철¹ , 이장훈¹ , 박선희¹ , 강정규¹ , 양동헌¹ , 박헌식¹ , 조용근¹ , 전재은¹ , 박의현 ¹ , 김영조² , 정명호³ , 김기식⁴ ,허승호5 ,성인환6 , 홍택종7 , 조명찬8 , 김종진9 |
Background: Statins have been shown to improve major adverse cardiac events (MACE) in previous studies of patients with symptomatic chronic heart failure (HF). However, the efficacy of statin in acute HF after acute myocardial infarction (AMI) remains unclear. Methods: Between November 2005 and January 2008, 2,172 statin-naive patients (1,432 men; mean age = 68.0 ± 12.2 years-old) who had acute HF of Killip class II-IV or left ventricular dysfunction with an ejection fraction of less than 40% were selected from the Korea AMI registry. Lipid levels were obtained within the first 24 hours of admission. The MACE was defined as a composite of death, non-fatal MI, and revascularizations. Results: Patients receiving statins at baseline (n=1,518) were younger with fewer in Killip class II-IV, fewer renal dysfunction, fewer cardiogenic shock, more with an smokers, higher body mass index, higher low density lipoprotein cholesterol (LDL-C) levels, more on antiplatelet agents and angiotensin converting enzyme inhibitors use. In Cox proportional-hazards model, the 6-month MACE (11.2% versus 17.9%; crude hazard ratio [HR] 0.592, 95% confidence interval [CI] 0.468–0.749; p<0.001) and mortality (8.4% versus 17.0%; crude HR 0.468, 95% CI 0.362–0.603; 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 604 patients not receiving statin with 604 patients receiving statin. During the follow-up, 182 (15.1%) MACEs including death, recurrent MI, and revascularization and 158 (13.1%) deaths from any cause occurred in the matched cohort. In Cox proportional-hazards model, there were no significant differences in the rate of 6-month MACE (14.4% versus 15.7%; HR 0.895, 95%CI 0.669–1.198; p=0.457) and mortality (11.4% versus 14.7%; HR 0.757, 95%CI 0.553–1.037; p=0.083) between statin and no-statin patients. Conclusions: Although the benefit of statin in acute HF after AMI for reducing 6-month MACE and mortality was substantial before PS match, these benefits could not be maintained after PS match. Clinicians should have caution in statin use during the acute phase of AMI complicated by HF, particularly in patients with low LDL-C levels.
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