Abstract 2043: Influence Of Statin Therapy On Long-term Clinical Outcomes Following Percutaneous Coronary Intervention
Background: Statins are beneficial in many coronary artery disease (CAD) subgroups. We assessed statin use and impact on clinical outcomes 3.5 years after Percutaneous Coronary Intervention (PCI).
Methods: Retrospective cohort study. All consecutive patients undergoing PCI in Nova Scotia between 1st July 2002 and 31st December 2003 were identified using the APPROACH database. Outcomes for 1468/1503 eligible patients (98% of cohort) censored on 31st December 2005 are reported. A 21 compartment Cox regression model was used to analyze the effect of statin therapy on major adverse cardiac events (MACE).
Results: 48% of patients were admitted on statin therapy prior to PCI and 82% were discharged on statins after PCI. The median follow-up period was 2.5 years. During PCI hospitalization, 16% never received statins, 3% had statins discontinued, 45% were maintained on statins and 36% had statins commenced. The corresponding baseline total cholesterol to high-density lipoprotein ratios for these groups were 4.9±1.5, 4.1 ± 1.4, 4.4 ± 1.4 and 5.4 ± 1.8 respectively (p<0.001). The crude cumulative incidence of 3.5 year MACE was strikingly lower in patients discharged on statins versus those who were not (15% vs 39%; p<0.001). This corresponded with an adjusted hazard ratio for 3.5 year MACE for patients discharged on statin therapy of 0.6 (0.5– 0.9; p=0.004). The adjusted hazard ratios of 3.5 year MACE for patients who had statins discontinued, maintained or commenced versus those who never received statins were 1.5 (0.8 –2.7; p=NS), 0.6 (0.4 – 0.9; p=0.01) and 0.8 (0.6 –1.1; p=0.2) respectively. The corresponding adjusted hazard ratio for 3.5 year MACE in patients maintained versus patients commenced on statins was 0.8 (0.6 to 1.1, p=0.1).
Conclusions: Statin treatment post PCI significantly reduced MACE for up to 3.5 years. The hazard of MACE was significantly lower for patients on statins from admission through to discharge versus those who never received statin therapy. Patients discharged on statins had a trend to lower MACE if they were already on this medication at the time of admission versus corresponding patients who were not. Optimization of statin therapy before and after PCI may result in a significant and durable improvement in clinical outcomes.