Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;49(5):419-433.
doi: 10.4070/kcj.2018.0341. Epub 2019 Feb 12.

Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naïve Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Min Chul Kim  1 , Youngkeun Ahn  2 , Jae Yeong Cho  1 , Ki Hong Lee  1 , Doo Sun Sim  1 , Nam Sik Yoon  1 , Hyun Ju Yoon  1 , Kye Hun Kim  1 , Young Joon Hong  1 , Hyung Wook Park  1 , Ju Han Kim  1 , Myung Ho Jeong  1 , Jeong Gwan Cho  1 , Jong Chun Park  1 , Kiyuk Chang  3 , Ki Bae Seung  3
Affiliations

Benefit of Early Statin Initiation within 48 Hours after Admission in Statin-Naïve Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Min Chul Kim et al. Korean Circ J. 2019 May.

Abstract

Background and objectives: Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation.

Methods: A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24-48 hours) and group 3 (≥48 hours). We also made 3 stratified models to reduce bias: model 1 (<24 hours vs. ≥24 hours), model 2 (<48 hours vs. ≥48 hours) and model 3 (<24 hours vs. 24-48 hours). The endpoint was major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction and target-vessel revascularization) during median 3.8 years.

Results: During follow-up, incidence of MACE was lower in early statin group in both model 1 (14.3% vs. 18.4%, hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91; p=0.002) and model 2 (14.6% vs. 19.7%, HR, 0.81; 95% CI, 0.67-0.97; p=0.022). After propensity-score matching, results remained unaltered. Statin initiation <24 hours reduced MACE compared to statin initiation ≥24 hours in model 1. Statin initiation <48 hours also reduced MACE compared to statin initiation later in model 2. However, there was no difference in incidence of MACE between statin initiation <24 hours and 24-48 hours) in model 3.

Conclusions: Early statin therapy within 48 hours after admission in statin-naïve patients with AMI reduced long-term clinical outcomes compared with statin initiation later.

Trial registration: ClinicalTrials.gov Identifier: NCT02385682.

Keywords: Hydroxymethylglutaryl-CoA reductase inhibitors; Myocardial infarction; Percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Kaplan-Meier curves for cumulative incidence of cardiac death, myocardial infarction or TVR in patients who received statin <24 hours vs. ≥24 hours (A), <48 hours vs. ≥48 hours (B), and <24 hours vs. 24–48 hours (C) after admission.
AMI = acute myocardial infarction; MI = myocardial infarction; TVR = target-vessel revascularization.
Figure 2
Figure 2. Subgroup analysis of major adverse cardiac events in model 2 (<48 hours vs. ≥48 hours).
CI = confidence interval; DM = diabetes mellitus; GFR = glomerular filtration rate; LAD = left anterior descending; LCX = left circumflex; LM = left main; LVEF = left ventricular ejection fraction; NSTEMI = non-ST-segment elevation myocardial infarction; RCA = right coronary artery; STEMI = ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

References

    1. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018;39:119–177. - PubMed
    1. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2016;37:267–315. - PubMed
    1. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140. - PubMed
    1. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139–228. - PubMed
    1. Kim MC, Ahn Y, Cho KH, et al. Early statin therapy within 48 hours decreased one-year major adverse cardiac events in patients with acute myocardial infarction. Int Heart J. 2011;52:1–6. - PubMed

Associated data