Abstract 12531: Post-Discharge Statin Withdrawal Had a Deleterious Impact on Long-Term Clinical Outcomes in Patients With Acute Myocardial Infarction
Introduction: Many patients discontinue statin after acute myocardial infarction (AMI) despite its necessity. However, limited data are available describing the clinical impact of statin withdrawal after AMI.
Hypothesis:The aim of this study was to evaluate the clinical outcomes of statin withdrawal in surviving patients after acute myocardial infarction (AMI).
Methods: A total of 3807 patients in the COnvergent REgistry of cAtholic and chonnAm university for Acute MI (COREA-AMI) from 2004 to 2009 who survived for 1 year after AMI were enrolled. All patients were prescribed statin at discharge and were divided into two groups on the basis of statin withdrawal history: 603 patients had a history of statin discontinuation and 3204 patients continued statin therapy for 1 year after AMI. The primary outcome was mortality from any cause. We also analyzed the incidence of cardiac death, nonfatal MI, any revascularization and stroke from 1 year after AMI. The duration of follow-up was 4 years after AMI.
Results: Statin withdrawal was associated with higher mortality than was continued statin treatment (hazard ratio [HR]: 3.45; 95% confidence interval [CI]: 2.81-4.24; p <0.001), primarily as the result of increased cardiac mortality (HR: 4.65; 95% CI: 3.14-6.87; p <0.001). However, the incidences of nonfatal MI, any revascularization and stroke were not significantly different between the groups. Analysis by propensity score matching (577 patients in both groups) did not significantly affect the results (HR: 3.14; 95% CI: 2.34-4.22; p <0.001 for mortality and HR: 4.01, 95% CI: 2.34-7.13, p <0.001 for cardiac mortality, respectively). In subgroup analysis, statin withdrawal was also associated with increased mortality in elderly or non-elderly, male or female, patients with ST- or non-ST-segment elevation myocardial infarction, diabetics or non-diabetics, and patients with left ventricular ejection fraction ≥ or < 45% without significant interaction.
Conclusions: Many patients experienced statin withdrawal after AMI, which significantly increased long-term mortality. Careful education and monitoring are needed to reduce adverse cardiac outcomes in patients after AMI.
Author Disclosures: M. Kim: None. H. Jeong: None. K. Park: None. D. Sim: None. Y. Hong: None. J. Kim: None. M. Jeong: None. J. Cho: None. J. Park: None. Y. Ahn: None.
- © 2014 by American Heart Association, Inc.