Key result
High-intensity statin pretreatment linked to ~30% lower odds of STEMI vs. low-intensity or no statins.
Why the study?
Through hypolipidemic and pleiotropic effects, statins stabilize coronary plaque and may prevent STEMI events, prompting investigation into whether contemporary statin pretreatment intensity and LDL-C levels associate with STEMI versus NSTE-ACS presentation.
Does high-intensity statin pretreatment reduce the incidence of STEMI presentation in patients admitted with acute coronary syndrome?
Cohort (n=5,103)
Yes
Does high-intensity statin pretreatment reduce the incidence of STEMI presentation in patients admitted with acute coronary syndrome?
Effect estimate: ORadj 0.70 (95% CI 0.57-0.86)
Absolute Event Rate: 31% vs 54%
p-value: p=<0.001
Pretreatment with high-intensity statins, but not low-intensity statins or achieving LDL-C < 70 mg/dL, is associated with a lower probability of presenting with STEMI rather than NSTE-ACS.
High-intensity statin pretreatment was associated with lower STEMI presentation in ACS; hypothesis-generating and requires randomized confirmation before practice change.
Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and may prevent STEMI events. This study investigated the association between contemporary statin pretreatment intensity, low-density lipoprotein cholesterol (LDL-C) levels, and the type of acute coronary syndrome (ACS) presentation: STEMI vs. NSTE-ACS. Data were drawn from the ACS Israeli Survey (ACSIS), a biennial prospective national survey that took place in 2008–2018. The rate of STEMI vs. NSTE-ACS was calculated by statin use, including statin intensity (high-intensity statin therapy (HIST) and low-intensity statin therapy (LIST) prior to the index ACS event. Among 5103 patients, 2839 (56%) were statin-naive, 1389 (27%) used LIST and 875 (17%) used HIST. Statin pretreated patients were older and had a higher rates of co-morbidities, cardiovascular disease history and pretreatment with evidence-based medications. STEMI vs. NSTE-ACS was lower among HIST vs. LIST vs. statin-naive patients (31.0%, 37.8%, and 54.0%, respectively, p for trend < 0.001). Multivariate analysis revealed that HIST was independently associated with lower STEMI presentation (ORadj 0.70; 95% CI 0.57–0.86), while LIST (ORadj 0.92; 95% CI 0.77–1.10) and LDL-C < 70 mg/dL (ORadj 0.96; 95% CI 0.82–1.14) were not. In conclusion, among patients admitted with ACS, pretreatment with HIST was independently associated with a lower probability of STEMI presentation, while LIST and LDL-C < 70 mg/dL were not.
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Dadon et al. (2021) conducted a cohort in Acute coronary syndrome (ACS) (n=5,103). High-intensity statin therapy (HIST) pretreatment vs. Low-intensity statin therapy (LIST) and statin-naive was evaluated on STEMI vs. NSTE-ACS presentation (ORadj 0.70, 95% CI 0.57-0.86, p=<0.001). Pretreatment with high-intensity statin therapy was independently associated with a lower probability of STEMI presentation compared to low-intensity or no statin therapy (ORadj 0.70; 95% CI 0.57-0.86).
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