Background: It has been reported that stent thrombosis (ST) is accelerated in acute inflammatory status and statin has a pleotrophic anti-inflammatory effect.
Methods: 9,162 acute myocardial infarction (AMI) patients (mean age = 64.4±12.5 years, 6,702 males, 5,626 ST segment elevation MI) who underwent coronary stent implantation were analyzed retrospectively in the Korean AMI Registry (KAMIR) and Korean Working Group of MI (KorMI). The study population were divided into two groups according to level of high sensitivity C-reactive protein (hs-CRP); low hs-CRP group (hs-CRP ≤ 2.0 mg/L, n = 3,408) or high hs-CRP group (hs-CRP > 2 mg/L, n = 4,182). Both hs-CRP groups were re-classified by peri-procedural statin treatment: low hs-CRP without statin group (n = 763), low hs-CRP with statin group (n = 2,645), high hs-CRP without statin group (n = 1,421), and high hs-CRP with statin group (n = 4,333). We evaluated the incidences of early ST (occurred within 30 days after stent implantation) and various major adverse cardiac events at 12 months in each groups.
Results: The more early STs were developed in high hs-CRP group rather than low hs-CRP group (0.5 % vs. 1.0 %, p = 0.012). Statin therapy did not affect the development of early ST in low hs-CRP group [with statin group: 0.6 % vs. without statin group: 0.4 %, adjusted odds ratio (OR): 1.362, 95 % confidence interval (CI): 0.374 to 4.953, p = 0.640]. However in high hs-CRP group, the incidence of early ST was significantly decreased with statin treatment [with statin group: 0.9 %, without statin group: 1.5 %, adjusted OR: 0.541, 95 % CI: 0.311 to 0.940, p = 0.029]. In subgroup analysis of high hs-CRP group, below 65-year-old patients, non diabetic patients, patients with body mass index (BMI)≥25.0 kg/m2, patients with high killip class, NSTEMI patients, patients with drug eluting stent implantation seemed to get more benefits from the statin therapy. In multivariate logistic regression analysis of high hs-CRP group, bare metal stent implantation and BMI≥25 kg/m2, lack of statin were significant predictor of incidence of ST (p = 0.001, p = 0.017, p = 0.029, respectively). And statin was effective in reduction of MACEs at 12 months in both hs-CRP groups.
Conclusions: Peri-procedural statin treatment not only had an effect on long term clinical outcomes but also reduced incidences of ST in AMI patients with high level of hs-CRP. These results may provide the rationale for the use of peri-procedural statin therapy in AMI patients with high hs-CRP level, regardless of lipid profiles.
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