Nicolas Danchin1, Michel Farnier2, Marianne Zeller2, Etienne Puymirat3, Yves Cottin2, Loïc Belle4, Gilles Lemesle5, Guillaume Cayla6, Patrick Ohlmann7, Laurent Jacquemin8, Thibault Perret9, Denis Angoulvant10, Franck Albert11, Jean Ferrières12, François Schiele13, Tabassome Simon14. 1. Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France. Electronic address: nicolasdanchin@yahoo.fr. 2. Department of Cardiology, Hôpital du Bocage, EA 7460 Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne-Franche Comté, Dijon, France. 3. Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France. 4. Department of Cardiology, Centre Hospitalier Annecy Genevois, Annecy, France. 5. USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France. 6. Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Nîmes, France. 7. Department of Cardiology, Centre Hospitalier Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France. 8. Department of Cardiology, Hôpital Emile Muller, Mulhouse, France. 9. Department of Cardiology, Hôpital Saint Joseph et Saint Luc, Lyon, France. 10. Department of Cardiology, Hôpital Trousseau, Université de Tours, Tours, France. 11. Department of Cardiology, Centre Hospitalier de Chartres, Le Coudray, France. 12. Department of Cardiology, Hôpital Jean Minjoz, Toulouse University Hospital, Toulouse University School of Medicine, INSERM UMR 1027, Toulouse, France. 13. Department of Cardiology, Hôpital Jean Minjoz, Hôpital Jean Minjoz, Université de Bourgogne-Franche-Comté, Besançon, France. 14. Department of Pharmacology, Hôpital St Antoine, Université Pierre et Marie Curie, Paris, France.
Abstract
BACKGROUND: Patients with familial hypercholesterolemia (FH) are prone to develop acute myocardial infarction (AMI) at a younger age. OBJECTIVES: The aim of the present study was to assess 5-year outcomes after AMI according to the presence of FH in a large multicenter cohort of patients. METHODS: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction consists of nationwide surveys recruiting patients over a 1- to 2-month period every 5 years. Patients recruited in 2005 and 2010 were followed up to 5 years. RESULTS: Of 5147 patients discharged alive and in whom FH status could be assessed, 2.8% had probable/definite FH, using an adapted Dutch Lipid Clinic score. They were 12 years younger, on average, than non-FH patients. Before adjustment, their 5-year survival and event-free survival did not differ from non-FH patients. After adjustment, however, both mortality (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.15-2.89; P = .011) and the combined endpoint of death, AMI, or stroke (HR 2.22, 95% CI: 1.51-3.26; P < .001) were higher in FH patients. The higher risk in FH patients was also present in patients receiving high-intensity lipid-lowering therapy at discharge: adjusted HR for mortality 2.29, 95% CI: 1.18 to 4.47, P = .015; HR for cardiovascular events 2.57, 95% CI: 1.48 to 4.48, P = .001. Concordant results were observed in propensity score-marched cohorts. CONCLUSIONS: The risk of long-term mortality and cardiovascular events is twice as high in FH than in non-FH patients, when adjusted on baseline characteristics, even for those receiving high-intensity lipid-lowering therapy. Additional therapeutic measures are needed in these patients.
BACKGROUND:Patients with familial hypercholesterolemia (FH) are prone to develop acute myocardial infarction (AMI) at a younger age. OBJECTIVES: The aim of the present study was to assess 5-year outcomes after AMI according to the presence of FH in a large multicenter cohort of patients. METHODS: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction consists of nationwide surveys recruiting patients over a 1- to 2-month period every 5 years. Patients recruited in 2005 and 2010 were followed up to 5 years. RESULTS: Of 5147 patients discharged alive and in whom FH status could be assessed, 2.8% had probable/definite FH, using an adapted Dutch Lipid Clinic score. They were 12 years younger, on average, than non-FHpatients. Before adjustment, their 5-year survival and event-free survival did not differ from non-FHpatients. After adjustment, however, both mortality (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.15-2.89; P = .011) and the combined endpoint of death, AMI, or stroke (HR 2.22, 95% CI: 1.51-3.26; P < .001) were higher in FHpatients. The higher risk in FHpatients was also present in patients receiving high-intensity lipid-lowering therapy at discharge: adjusted HR for mortality 2.29, 95% CI: 1.18 to 4.47, P = .015; HR for cardiovascular events 2.57, 95% CI: 1.48 to 4.48, P = .001. Concordant results were observed in propensity score-marched cohorts. CONCLUSIONS: The risk of long-term mortality and cardiovascular events is twice as high in FH than in non-FHpatients, when adjusted on baseline characteristics, even for those receiving high-intensity lipid-lowering therapy. Additional therapeutic measures are needed in these patients.