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. 2023 Nov 15:207:479-489.
doi: 10.1016/j.amjcard.2023.09.047. Epub 2023 Oct 3.

Statin Discontinuation After Coronary Revascularization

Ko Yamamoto  1 , Takeshi Morimoto  2 , Masahiro Natsuaki  3 , Hiroki Shiomi  4 , Manabu Ogita  5 , Tomohisa Tada  6 , Toshiaki Toyota  7 , Kenji Nakatsuma  8 , Natsuhiko Ehara  7 , Kyohei Yamaji  4 , Junichi Tazaki  9 , Mamoru Toyofuku  9 , Takafumi Yokomatsu  8 , Kazushige Kadota  10 , Kenji Ando  1 , Takeshi Kimura  11 ; CREDO-Kyoto PCI/CABG Registry Cohort-3 Investigators
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Statin Discontinuation After Coronary Revascularization

Ko Yamamoto et al. Am J Cardiol. .

Abstract

There is a scarcity of studies evaluating statin discontinuation in patients with coronary artery disease in real-world practice. In 11,144 patients who underwent first coronary revascularization and taking statins in the CREDO-Kyoto Registry Cohort-3, we evaluated the incidence of statin discontinuation, defined as stopping statins for at least 2 months. The reasons for statin discontinuation included nonadherence, side effects, worsening co-morbidities, surgery, prescription error, and direction by physicians for other reasons. During a median 6 years of follow-up, the cumulative incidence of statin discontinuation was 6.1% at 1 year, 12.4% at 3 years, 17.4% at 5 years, and 21.4% at 7 years. The major components of the reasons for statin discontinuation were nonadherence, side effects, and worsening co-morbidities. Compared with patients with statin discontinuation because of other reasons, patients with statin discontinuation because of nonadherence more often had younger age, men, acute coronary syndrome, and current smoking; patients with statin discontinuation because of side effects more often had liver cirrhosis; and patients with statin discontinuation because of worsening co-morbidities more often had advanced age and co-morbidities such as malignancy. Statin discontinuation was strongly associated with subsequent mortality (hazard ratio [HR] 3.54; 95% confidence interval [CI] 3.18 to 3.94, p <0.001), which was consistent, regardless of the reasons, except for the small group of patients with prescription error (nonadherence: HR 2.35, 95% CI 1.69 to 3.27, p <0.001; side effects: HR 2.48, 95% CI 1.84 to 3.34, p <0.001; worsening co-morbidities: HR 22.08, 95% CI 18.55 to 26.29, p <0.001). In conclusion, in real-world practice, approximately 1 in 5 patients discontinued statins after coronary revascularization during a median of 6 years of follow-up. Statin discontinuation was associated with subsequent mortality.

Keywords: coronary artery bypass grafting; percutaneous coronary intervention; statin.

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Conflict of interest statement

Declaration of Competing Interest Dr. Morimoto reports lecturer's fees from Bayer, Daiichi Sankyo, Japan Lifeline, Kyocera, Mitsubishi Tanabe, Novartis, and Toray and manuscript fees from Bristol-Myers Squibb and Kowa and served advisory boards for Asahi Kasei, Boston Scientific, Bristol-Myers Squibb, and Sanofi. Dr. Shiomi reports personal fees from Abbott Vascular, Boston Scientific, and Daiichi Sankyo. Dr. Ehara reports personal fees from Abbott vascular Japan, Bayer, Boehringer Ingelheim (Bristol), Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Edwards Lifescience, Medtronic, Pfizer (New York, NY, United States), Takeda, and Terumo. Dr. Kimura reports personal fees from Abbott Vascular, Abiomed, Astellas, Astellas Amgen BioPharma, AstraZeneca, Bayer, Boston Scientific, Boehringer Ingelheim-Myers Squibb, Chugai Pharmaceutical, Edwards Lifescience, EISAI, Daiichi Sankyo, Interscience, Japan Society for the Promotion of Science, Kowa, Kowa Pharmaceutical, Lifescience, Medical Review, MSD, MSD Life Science Foundation, Mitsubishi Tanabe Pharma, Novartis Pharma, Ono Pharmaceutical, OrbusNeich, Otsuka Pharmaceutical, Pharmaceuticals and Medical Devices Agency, Philips, Public Health Research Foundation, Sanofi, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Terumo, Toray, and Tsumura. The remaining authors have no competing interests to declare.

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