Influence of high-dose highly efficient statins on short-term mortality in patients undergoing percutaneous coronary intervention with stenting for acute coronary syndromes

Abstract

Statins are recommended for prevention of progression of cardiovascular disease after percutaneous coronary intervention (PCI). Although high-dose highly efficient statins are recommended, especially in high-risk patients, clinical data are scarce and further investigation in "real-world" settings is needed. One thousand five hundred twenty-eight consecutive patients, who underwent PCI for acute coronary syndrome, were included in a prospective registry from January 2003 to January 2011. In post hoc analysis, cardiovascular risk factors, co-morbidities, and circulating lipid parameters at the time of intervention were evaluated. As a primary end point, all-cause mortality after a follow-up period of 3 months was investigated. Results were compared between patients receiving high-dose highly effective statins (atorvastatin 80 mg or rosuvastatin 20 mg) versus patients receiving low-dose statins or who were without lipid-lowering therapy at the time of discharge. Nine hundred twenty-six patients (60.6%) received high-dose atorvastatin or rosuvastatin and 602 patients (39.4%) received low-dose statin therapy or were not on statins at discharge. Eight patients (0.9%) receiving high-dose statin therapy and 21 patients (3.5%) taking low-dose statins or no statins at discharge died during the 3-month follow-up (hazard ratio 0.244, 95% confidence interval 0.108 to 0.551, p=0.001). After propensity score adjustment the results remained significant (adjusted hazard ratio for high-dose statins 0.405, 95% confidence interval 0.176 to 0.931, p=0.033). In conclusion, in this single-center series of 1,528 real-world patients undergoing PCI for acute coronary syndrome, a significant reduction in short-term all-cause mortality could be demonstrated in patients receiving high-dose highly efficient statins compared with patients receiving low-dose statins or no lipid-lowering therapy.