Statin Users Have Better Outcomes After PCI for Stable CAD

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In patients with stable coronary artery disease (CAD), receiving statin therapy prior to undergoing percutaneous coronary intervention (PCI) reduces the risk of death or recurrent acute coronary syndromes (ACS) in the short and long term, researchers report in a study published online June 28, 2011, ahead of print in Circulation: Cardiovascular Quality and Outcomes.

Investigators led by Dennis T. Ko, MD, MSc, of the Institute for Clinical Evaluative Sciences (Toronto, Canada), conducted an observational study of 12,980 patients over age 65 with stable CAD who underwent PCI from December 2003 through March 2008. Propensity scoring was used to match 3,098 pairs (6,196 patients) who did or did not receive preprocedural statins. At 90 days, the primary outcome of death or ACS occurred less frequently in the preprocedural statin group compared with the no-pretreatment group. Improved clinical outcomes in the preprocedural statin group persisted out to 2 years (table 1).

Table 1. Death or Recurrent ACS

 

Preprocedural Statins
(n = 3,098)

No Statin
(n = 3,098)

90 Days

5.6%

7.4%

6 Months

7.8%

9.9%

1 Year

11.4%

13.2%

2 Years

16.7%

19.3%

P = 0.005 for all time periods.

The individual outcomes of death and recurrent ACS also favored preprocedural statins. At 2 years, mortality was 8.8% in the preprocedural statin group vs. 10.6% in the no statin group (P = 0.01). Similarly, the rate of recurrent ACS at 2 years was 9.1% vs. 10.3% (P = 0.07).

After adjustment for postprocedural statin use, the clinical benefit of preprocedural therapy was most pronounced at 90 days after PCI (adjusted HR 0.80; 95% CI 0.65-0.98) and was still evident at 6 months (adjusted HR 0.82; 95% CI 0.69-0.98) but was no longer significant at 1 year (adjusted HR 0.92; 95% CI 0.79-1.07).

Statins Important Before and After PCI

“Our findings lend strong support for the routine use of preprocedural statins for patients with stable coronary artery disease undergoing PCI,” the study authors write. “In addition, our study should reinforce the importance of statin therapy after PCI because of its strong association with improved clinical outcomes.”

Dr. Ko and colleagues observe that none of the previous studies that looked at preprocedural statins evaluated whether the benefits may be related to a difference in the prescribing of postprocedural statins. In the current study, patients who received preprocedural statins were significantly more likely to receive statins after PCI, and the gap widened over time. Nonetheless, preprocedural statin use was seen to improve short-term outcomes.

Making a broader point, the authors write that despite the known importance of medical therapy for patients with CAD, 30% were not prescribed statins, 38% were not prescribed beta-blockers, and 64% were not receiving an ACE inhibitor or angiotensin II receptor blocker before PCI.

They conclude that “improved utilization of any of these medications may be an opportunity for improvement in care of patients with cardiovascular disease after PCI” and that efforts to encourage adherence to statin therapy before and after PCI may lead to improved outcomes.

Study Details 

To identify users of preprocedural statins, the researchers reviewed the Ontario Drug Benefit database for prescription claims within 90 days before PCI.

The mean age of the cohort before propensity-score matching was 73.8 years, 66.7% were men, and 34.2% had diabetes. Statin therapy was prescribed to 70.1% before PCI. Patients who were prescribed preprocedural statins had significantly more medical comorbidities and prior coronary revascularizations. They were also more likely to receive other evidence-based medical therapies (ie, beta-blockers, ACE inhibitors or angiotensin receptor blockers, or thienopyridines) before PCI.

The mean age of the propensity-matched cohort was 74.1 years, 64.2% were men, and 30.2% had diabetes. The majority of patients who received preprocedural statins were prescribed atorvastatin (57.7%), followed by simvastatin (18.3%) and rosuvastatin (16.1%).

 


Source:
Ko DT, Wijeysundera HC, Yun L, et al. Effectiveness of preprocedural statin therapy on clinical outcomes for patients with stable coronary artery disease after percutaneous coronary interventions. Circ Cardiovasc Qual Outcomes. 2011;4:459-466.

 

 

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Disclosures
  • The study was funded by a Canadian Institutes of Health Research (CIHR) grant.
  • Dr. Ko reports no relevant conflicts of interest.

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