Jaelim Cho1, Ie Byung Park2, Kiyoung Lee2, Tae Hoon Ahn2, Won Bin Park3, Ju Han Kim4, Youngkeun Ahn4, Myung Ho Jeong5, Dae Ho Lee6. 1. Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. 2. Department of Internal Medicine, Gachon University College of Medicine, Incheon, Republic of Korea; Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. 3. Deparment of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea; Department of Emergency Medical Service, College of Health Science, Gachon University, Incheon, Republic of Korea. 4. Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. 5. Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net. 6. Department of Internal Medicine, Gachon University College of Medicine, Incheon, Republic of Korea; Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea; Lee Gil Ya Cancer and Diabetes Institute, Incheon, Gachon University, Incheon, Republic of Korea. Electronic address: drhormone@naver.com.
Abstract
BACKGROUND: The benefit of statin therapy in patients with higher grades of heart failure has yet to be determined. The present study investigated whether statin therapy affects major composite outcomes (MCOs) and all-cause mortality in patients with acute myocardial infarction (AMI) within 1 year after AMI, according to their plasma natriuretic peptide (NP) levels and left ventricular ejection fraction (LVEF). METHODS: A total of 11,492 patients with AMI from two nationwide registry databases in Korea were analyzed. AMI patients were divided into quartiles by plasma levels of B-type NP (BNP) or N-terminal pro-BNP (NT-proBNP) at admission. Patients with LVEF <40% on initial echocardiography were also evaluated. Total mortality and MCOs within 12 months of AMI, including death, nonfatal MI, and revascularization, were assessed. RESULTS: Among AMI patients, statin therapy was included in the discharge medications for 9075 (79.0%) patients, but not for the remaining 2417 patients (21.0%), and statin therapy was associated with a 27.8% lower risk of MCOs. After adjusting for risk factors, statin therapy was associated with lower hazard ratios for MCOs and all-cause mortality in only the third and fourth NP quartile subgroups, being effective only with moderate- to high-intensity statin therapy. However, statins did not modify the outcomes in patients with LVEF <40%. CONCLUSIONS: Our results show that moderate- to high-intensity statin therapy was associated with a lower risk of major clinical outcomes and all-cause mortality in AMI patients with higher plasma NP, but not in AMI patients with decreased LVEF.
BACKGROUND: The benefit of statin therapy in patients with higher grades of heart failure has yet to be determined. The present study investigated whether statin therapy affects major composite outcomes (MCOs) and all-cause mortality in patients with acute myocardial infarction (AMI) within 1 year after AMI, according to their plasma natriuretic peptide (NP) levels and left ventricular ejection fraction (LVEF). METHODS: A total of 11,492 patients with AMI from two nationwide registry databases in Korea were analyzed. AMI patients were divided into quartiles by plasma levels of B-type NP (BNP) or N-terminal pro-BNP (NT-proBNP) at admission. Patients with LVEF <40% on initial echocardiography were also evaluated. Total mortality and MCOs within 12 months of AMI, including death, nonfatal MI, and revascularization, were assessed. RESULTS: Among AMI patients, statin therapy was included in the discharge medications for 9075 (79.0%) patients, but not for the remaining 2417 patients (21.0%), and statin therapy was associated with a 27.8% lower risk of MCOs. After adjusting for risk factors, statin therapy was associated with lower hazard ratios for MCOs and all-cause mortality in only the third and fourth NP quartile subgroups, being effective only with moderate- to high-intensity statin therapy. However, statins did not modify the outcomes in patients with LVEF <40%. CONCLUSIONS: Our results show that moderate- to high-intensity statin therapy was associated with a lower risk of major clinical outcomes and all-cause mortality in AMI patients with higher plasma NP, but not in AMI patients with decreased LVEF.