Abstract 17558: Patients Developing Acute Myocardial Infarction despite low Levels of LDL-c are at Increased Long-term Risk
Introduction: Elevated LDL-c is a recognized risk factor for coronary artery disease (CAD). However, AMI may occur in patients with low LDL-c levels. Whether such patients have long-term outcomes similar to other AMI patients is not known.
Methods: We evaluated the characteristics and 3-year outcomes associated with AMI in patients with low LDL-c (<70 mg/dl in those on statins, and <100 mg/dl in those without statins) in the French FAST-MI 2010 registry, which collected information on all patients admitted for AMI in 76% of French institutions at the end of 2010. Three-year follow-up was 97% complete.
Results: Of 4,169 patients admitted to ICCU with AMI, 3073 had LDL-c measurements on admission available, of whom 767 (25%) had low LDL-c levels. Patients with low LDL-c were older (68 ± 14 vs 63 ± 14 yrs), had more diabetes (31 v 15%), were less often smokers (26 v 40%) and had more previously known CAD (33 v 20%). Previous treatment with statins (26 v 26) and BMI did not differ. In-hospital death was higher (2.7% vs 1.0%). At discharge, statins were less often prescribed (90 v 94.5%), but aspirin, beta-blockers and ACE-I or ARBs were similar. In hospital survivors, 3-year survival was 84% vs 92% (P<0.001); 85 vs 94% in patients without statins before, and 79 vs 87% in those with statins before index AMI. The composite of death, MI or stroke was 82 vs 90%, P<0.001. After Cox multivariate adjustment on baseline characteristics, in-hospital management and discharge medications, HR for 3-yr death was 1.36, 1.05-1.75, P=0.018, and HR for MACE was 1.27, 1.02-1.59, P=0.03. Similar trends were found for patients with or without previous treatment with statins (Figure).
Conclusions: Patients developing AMI while having low LDL-c levels are at increased risk of 3-year mortality and CV events. New management strategies should be sought for such patients.
Author Disclosures: N. Danchin: Research Grant; Significant; Amgen, AstraZeneca, Bayer, BMS, Daiichi-Sankyo, Eli-Lilly, MSD, Pfizer, Sanofi, Servier. Other Research Support; Significant; CNAM-TS. Honoraria; Modest; Amgen, Bayer, BMS, Boehringer-Ingelheim, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novo-Nordisk, Servier. Honoraria; Significant; AstraZeneca, Sanofi. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, Bayer, GSK, Novo-Nordisk, Servier. Consultant/Advisory Board; Significant; Sanofi. M. Elbaz: None. B. Popovic: None. F. Beygui: None. L. Jacquemin: None. G. Cayla: None. P. Ohlmann: None. F. Prunier: None. M. Pansieri: None. E. Puymirat: None. F. Schiele: None. J. Ferrieres: None. T. Simon: None.
- © 2016 by American Heart Association, Inc.