Abstract 10614: Renal Function and Effect of Statin Therapy on Cardiovascular Outcomes in Patients Undergoing Coronary Revascularization: An observation from the CREDO-Kyoto Registry Cohort-2

Abstract

Background: Statin therapy is essential for cardiovascular secondary prevention. However, therapeutic effect of statins on cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated.

Methods: In the CREDO-Kyoto registry Cohort-2, 14706 patients who underwent first coronary revascularization were divided into 4 strata based on the estimated glomerular filtration rate (eGFR) or the status of hemodialysis (HD). Patients in each stratum were further divided into 2 groups based on the statin therapy at discharge; Non-CKD stratum (eGFR≥60ml/min/1.73m²): 8959 patients (statin: N=4747, no-statin: N=4212), mild CKD stratum (30≤eGFR<60ml/min/1.73m²): 4567 patients (statin: N=2135, no-statin: N=2432), severe CKD stratum (eGFR<30ml/min/1.73m²): 608 patients (statin: N=229, no-statin: N=379) and HD stratum: 572 patients (statin: N=117, no-statin: N=455).

Results: Through 3-year follow-up, the cumulative incidence of major adverse cardiovascular events (MACE: a composite of cardiovascular death, myocardial infarction or stoke) was significantly lower in the statin group than in the no-statin group in non-CKD (6.8% vs. 8.7%, P=0.0006) and mild CKD stratum (9.4% vs. 13.9%, P<0.0001). In contrast, there was no significant difference in the incidence of MACE between the statin and no-statin groups in severe CKD (21.1% vs. 25.7%, P=0.34) and HD stratum (28.2% vs. 25.4%, P=0.49). In multivariate analysis, the risk for MACE was significantly lower in the statin group than in the no-statin group in non-CKD (HR 0.8 [95%CI 0.68-0.95], P=0.01) and mild CKD stratum (HR 0.69 [95%CI 0.56-0.84], P=0.0002). However, there was no significant difference in the risk for MACE between the 2 groups in severe CKD (HR 0.91 [95%CI 0.6-1.38], P=0.65) and HD stratum (HR 1.04 [95%CI 0.64-1.69], P=0.87).

Conclusions: Statin therapy was associated with significantly lower risk for MACE in non-CKD and mild CKD patients undergoing coronary revascularization. However, therapeutic benefits of statins were not found in severe CKD and HD patients. Statin therapy should be started at earlier stage of CKD to improve the cardiovascular outcomes in patients with renal dysfunction.