Abstract 12600: Treatment and Outcomes by LDL-C Level in Statin-Naïve Non-ST-Elevation Myocardial Infarction (NSTEMI) Patients: Findings From the CRUSADE Registry
Background: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased risk of myocardial infarction and is a target for disease prevention. The association between initial LDL-C and long-term mortality following NSTEMI has not been well characterized.
Methods: We linked detailed in-hospital data for 6647 statin naïve NSTEMI patients >65 years of age enrolled in the CRUSADE Registry (2003-2006) to CMS claims records for post-discharge outcomes. Patients reporting home statin use or prior cardiovascular disease were excluded. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for 3-year all-cause mortality across 4 categories of baseline LDL-C: very low( 130 mg/dL).
Results: The largest proportion of patients had LDL-C 100-129 mg/dL (31.2%), followed by LDL-C 70-99 mg/dL (29.8%), LDL-C >130 mg/dL (24.7%), and LDL-C≤70 mg/dL (14.3%). Patients in the lowest LDL-C category were older and had more comorbidities than patients in higher LDL-C categories (Table 1). Very low LDL-C patients were less likely to receive statins at discharge than patients with high or very high LDL-C. Patients with very low and low LDL-C had higher unadjusted mortality at 3 years. After adjustment for CRUSADE long-term mortality model variables, additional lipid values, in-hospital procedures and discharge statins, mortality was similar across LDL-C categories.
Conclusions: Statin-naïve NSTEMI patients with very low LDL-C are older, have more comorbidity, and less likely to be given statin at discharge than those with higher LDL-C. The higher 3-year mortality observed for these patients is largely accounted for by variation in statin treatment and underlying risk.
- © 2013 by American Heart Association, Inc.