Key result
In AMI patients with LDL-C ≤ 113 mg/dL, statin therapy did not significantly reduce 6-month MACE compared to no statin (9.4% vs 11.0%; HR 0.847; 95% CI 0.646-1.111; P=0.230).
Why the study?
Does statin therapy reduce 6-month MACE and mortality in statin-naive AMI patients with low LDL-C levels?
Cohort (n=6,866)
Yes
Does statin therapy reduce 6-month MACE and mortality in statin-naive AMI patients with low LDL-C levels?
Hazard Ratio: 0.847 (95% CI 0.646–1.111)
Absolute Event Rate: 9.4% vs 11%
p-value: p=0.230
The short-term beneficial effects of statin therapy in acute myocardial infarction may be attenuated or absent in patients with baseline LDL-C ≤ 105 mg/dL.
Statin therapy was not associated with lower 6-month MACE in low-LDL AMI; hypothesis-generating and should not yet change practice.
BACKGROUND: Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI). HYPOTHESIS: The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels. METHODS: Between November 2005 and January 2008, 6866 statin-naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations. RESULTS: The 6-month MACE and mortality showed a U-shaped curve, with the lowest rate at 114-122 mg/dL. Propensity scores for statin use were calculated for patients with LDL-C ≤ 113 mg/dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6-month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646-1.111, P = 0.230), whereas the 6-month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539-0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL-C ≤ 105 mg/dL, not only the 6-month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700-1.277, P = 0.713) but also the 6-month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566-1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group). CONCLUSIONS: The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.
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Lee et al. (2011) conducted a cohort in acute myocardial infarction (AMI) (n=6,866). Statin therapy vs. No statin therapy (statin nonuser) was evaluated on 6-month Major adverse cardiac event (MACE) (composite of death, recurrent MI, and revascularizations) (HR 0.847, 95% CI 0.646-1.111, p=0.230). In AMI patients with LDL-C ≤ 113 mg/dL, statin therapy did not significantly reduce 6-month MACE compared to no statin (9.4% vs 11.0%; HR 0.847; 95% CI 0.646-1.111; P=0.230).
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