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Comparative Study
. 2017 Apr 12;6(4):e005333.
doi: 10.1161/JAHA.116.005333.

Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction

Michael D Miedema  1   2 , Ross F Garberich  3 , Lucas J Schnaidt  3 , Erin Peterson  3 , Craig Strauss  3   2 , Scott Sharkey  3   2 , Thomas Knickelbine  3   2 , Marc C Newell  3   2 , Timothy D Henry  3   2   4
Affiliations
Comparative Study

Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction

Michael D Miedema et al. J Am Heart Assoc. .

Abstract

Background: The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear.

Methods and results: We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138] mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI.

Conclusions: In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.

Keywords: ST‐segment elevation myocardial infarction; cholesterol; prevention; statin.

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Figures

Figure 1
Figure 1
Lipid values (A), the prevalence of access to and utilization of primary and cardiovascular disease (CVD) outpatient care in the 2 years prior to ST‐segment elevation myocardial infarction (STEMI) in 1064 STEMI patients (B), and pre‐STEMI statin eligibility (C) according to the prior Third Report of the Adult Treatment Panel (ATP III) cholesterol guidelines and the current American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines in 727 patients not taking statin therapy prior to STEMI. HDL indicates high‐density lipoprotein; LDL, low‐density lipoprotein.
See this image and copyright information in PMC

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