Abstract 10286: Benefit of High-Dose Atorvastatin in Patients With Acute Coronary Syndromes After Recent Influenza-like Illness: Results From the PROVE IT-TIMI 22 Trial
Background: Patients with recent influenza-like illness (ILI) may have subclinical systemic inflammation that contributes to atherosclerotic plaque rupture and acute coronary syndrome (ACS). Whether recent ILI identifies high-risk ACS patients independent of established cardiovascular (CV) risk factors, and identifies patients who derive greater clinical benefit from intensive statin therapy, is unknown.
Methods: We prospectively assessed for a recent history of infection in 4,034 of patients with ACS who were randomized to 80 mg atorvastatin versus 40 mg pravastatin within the PROVE IT-TIMI 22 trial and followed for a mean of 2 years.
Results: By self-described history, 3,472 (86.1%) patients had no recent infection, 303 (7.5%) had recent ILI and 259 (6.4%) had other infections. Compared with patients without prior infection, recent ILI was not associated with an increased risk of the primary endpoint (composite of death, MI, re-hospitalization for UA, coronary revascularization, or stroke) after adjustment for clinical risk predictors and hsCRP (22.5% vs 24.1%, adjusted HR 0.78, 95% CI, 0.60-1.03, P=0.08). Likewise, no associated risk was observed among patients with other infections (22.9%, adjusted HR 0.99, 95% CI, 0.0.76-1.28, P=0.92). However, among patients with recent ILI, atorvastatin significantly reduced the incidence of the primary endpoint (15.8% vs 27.4%, HR 0.57, 95% CI, 0.34-0.95; P=0.03; Figure), similar to patients with no recent infection (22.2% vs 25.5%, HR 0.86, 95% CI, 0.75-0.99; P=0.03; P-interaction=0.30). There was no significant CV effect modification by infection status with gatifloxacin (p-interaction=0.55).
Conclusion: Survivors of a recent ILI who developed ACS did not have an increased risk for adverse CV events and derived similar benefit from intensive statin therapy compared with patients without recent infection. Further research into the magnitude and modifiability of CV risk after ILI in this setting is warranted.
- © 2013 by American Heart Association, Inc.