Abstract 15859: Statin Treatment Improves Long Term Clinical Outcomes in Acute Myocardial Infarction Patients with Left Ventricular Dysfunction: According to The Level of High-Sensitivity C-Reactive Protein
Objective: This study examined the anti-inflammatory effect of statins may benefit in acute myocardial infarction (AMI) patients with left ventricular (LV) dysfunction.
Background: AMI and LV dysfunction is a state characterized by inflammation and which low cholesterol is associated with worse outcome. And, statins have a pleotrophic anti-inflammatory effect.
Methods: 3970 patients with AMI and LV ejection fraction less than 50% by initial echocardiogram (mean age = 65.7 ± 12.6 years, 2829 males, 2687 ST elevation MI, 1283 non ST elevation MI) who underwent coronary stent implantation between January 2007 and March 2009 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into two groups; the low hs-CRP group (hs-CRP < 2 mg/dl, n = 1129,) or the high hs-CRP group (hs-CRP ≥2 mg/dl, n = 2841). We evaluated the incidence of major adverse cardiac events (MACE), including cardiac death, re-infarction, coronary artery bypass grafting, heart failure requiring rehospitalization, and target lesion revascularization during in hospital period and one year clinical follow up according to the statin therapy in each groups.
Results: The baseline clinical characteristics were similar between the groups including hemodynamic parameters, risk factor of atherosclerosis, laboratory parameters including lipid profiles, and coronary angiographic findings. The high hs-CRP group was associated with worse outcomes [Incidence rate of MACEs: 8.1% vs. 15.3%, p<0.001, hazard ratio (HR): 2.06, 95% confidence interval (CI): 1.63 to 2.62]. Statin therapy did not affect the incidence of MACEs in the low hs-CRP group [statin group: 7.2% (61/842) vs. no statin group: 10.5% (30/287), p=0.085, HR: 0.67, 95% CI: 0.42-1.06]. However in the high hs-CRP group, the incidence of MACEs was significantly decreased with statin treatment [statin group: 13.8% (286/2071), no statin group: 19.3% (148/766), p<0.001, HR: 0.67, 95% CI: 0.54-0.83]. In a multivariable Cox regression analysis of the high hs-CRP group, lack of statin therapy was a signi[[Unable to Display Character: ﬁ]]cant predictor of MACEs incidence (p=0.001, HR: 1.41, 95% CI: 1.15-1.72).
Conclusion: The statin treatment was associated with better outcomes in AMI and LV dysfunction patients with hs-CRP ≥2 mg/dl.
- © 2012 by American Heart Association, Inc.