Comparison of Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Discharged on Versus Not on Statin Therapy (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial)

Alf I. Larsen, Matthew I. Tomey, Roxana Mehran, Dennis W T Nilsen, Ajay J. Kirtane, Bernhard Witzenbichler, Giulio Guagliumi, Sorin J. Brener, Philippe Genereux, Ran Kornowski, Dariusz Dudek, Bernard J. Gersh, Gregg W. Stone

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Statin therapy is indicated after ST-segment elevation myocardial infarction (STEMI) to reduce recurrent ischemic events, but approximately 6% of patients with STEMI do not receive a statin prescription at discharge. This substudy aimed to define the clinical outcomes and patient characteristics associated with statin nonprescription after STEMI. We compared clinical, angiographic, and procedural characteristics and in-hospital, 30-day, 1-year, 2-year, and 3-year outcomes in 3,512 patients discharged after STEMI with and without (6%) statin prescriptions in the harmonizing outcomes with revascularization and stents in acute myocardial infarction trial (www.clinicaltrials.gov, NCT00433966). Statin nonprescription was associated with female sex, nonwhite race, previous bypass surgery, heart failure, renal impairment, anemia, thrombocytopenia, care in the United States, lower prescription rates of antiplatelets and neurohormonal antagonists, less percutaneous coronary intervention and stents, and, in 26% of cases, angiographically normal or nonobstructed coronary arteries. At every time point of follow-up after discharge, patients with no discharge statin prescription had significantly higher rates of net adverse clinical events, major adverse cardiac events, major bleeding unrelated to bypass surgery, and death. After multivariable adjustment, absence of a discharge statin prescription independently predicted 3-year major adverse cardiac event (hazard ratio 1.54, 95% confidence interval 1.15 to 2.07, p = 0.0037) and death (hazard ratio 2.30, 95% confidence interval 1.41 to 3.77, p = 0.0009). In conclusion, within the framework of this randomized trial of patients presenting with STEMI, approximately 6% of patients were discharged without statin therapy. Absence of a discharge statin prescription after STEMI was an independent predictor of ischemic events including death.

Original languageEnglish (US)
Pages (from-to)1273-1279
Number of pages7
JournalAmerican Journal of Cardiology
Volume113
Issue number8
DOIs
StatePublished - Apr 15 2014
Externally publishedYes

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Stents
Myocardial Infarction
Prescriptions
Therapeutics
Confidence Intervals
ST Elevation Myocardial Infarction
Patient Discharge
Percutaneous Coronary Intervention
Thrombocytopenia
Anemia
Coronary Vessels
Heart Failure
Hemorrhage
Kidney

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Larsen, Alf I. ; Tomey, Matthew I. ; Mehran, Roxana ; Nilsen, Dennis W T ; Kirtane, Ajay J. ; Witzenbichler, Bernhard ; Guagliumi, Giulio ; Brener, Sorin J. ; Genereux, Philippe ; Kornowski, Ran ; Dudek, Dariusz ; Gersh, Bernard J. ; Stone, Gregg W. / Comparison of Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Discharged on Versus Not on Statin Therapy (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial). In: American Journal of Cardiology. 2014 ; Vol. 113, No. 8. pp. 1273-1279.
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abstract = "Statin therapy is indicated after ST-segment elevation myocardial infarction (STEMI) to reduce recurrent ischemic events, but approximately 6{\%} of patients with STEMI do not receive a statin prescription at discharge. This substudy aimed to define the clinical outcomes and patient characteristics associated with statin nonprescription after STEMI. We compared clinical, angiographic, and procedural characteristics and in-hospital, 30-day, 1-year, 2-year, and 3-year outcomes in 3,512 patients discharged after STEMI with and without (6{\%}) statin prescriptions in the harmonizing outcomes with revascularization and stents in acute myocardial infarction trial (www.clinicaltrials.gov, NCT00433966). Statin nonprescription was associated with female sex, nonwhite race, previous bypass surgery, heart failure, renal impairment, anemia, thrombocytopenia, care in the United States, lower prescription rates of antiplatelets and neurohormonal antagonists, less percutaneous coronary intervention and stents, and, in 26{\%} of cases, angiographically normal or nonobstructed coronary arteries. At every time point of follow-up after discharge, patients with no discharge statin prescription had significantly higher rates of net adverse clinical events, major adverse cardiac events, major bleeding unrelated to bypass surgery, and death. After multivariable adjustment, absence of a discharge statin prescription independently predicted 3-year major adverse cardiac event (hazard ratio 1.54, 95{\%} confidence interval 1.15 to 2.07, p = 0.0037) and death (hazard ratio 2.30, 95{\%} confidence interval 1.41 to 3.77, p = 0.0009). In conclusion, within the framework of this randomized trial of patients presenting with STEMI, approximately 6{\%} of patients were discharged without statin therapy. Absence of a discharge statin prescription after STEMI was an independent predictor of ischemic events including death.",
author = "Larsen, {Alf I.} and Tomey, {Matthew I.} and Roxana Mehran and Nilsen, {Dennis W T} and Kirtane, {Ajay J.} and Bernhard Witzenbichler and Giulio Guagliumi and Brener, {Sorin J.} and Philippe Genereux and Ran Kornowski and Dariusz Dudek and Gersh, {Bernard J.} and Stone, {Gregg W.}",
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Comparison of Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Discharged on Versus Not on Statin Therapy (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial). / Larsen, Alf I.; Tomey, Matthew I.; Mehran, Roxana; Nilsen, Dennis W T; Kirtane, Ajay J.; Witzenbichler, Bernhard; Guagliumi, Giulio; Brener, Sorin J.; Genereux, Philippe; Kornowski, Ran; Dudek, Dariusz; Gersh, Bernard J.; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 113, No. 8, 15.04.2014, p. 1273-1279.

Research output: Contribution to journalArticle

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T1 - Comparison of Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Discharged on Versus Not on Statin Therapy (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial)

AU - Larsen, Alf I.

AU - Tomey, Matthew I.

AU - Mehran, Roxana

AU - Nilsen, Dennis W T

AU - Kirtane, Ajay J.

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Brener, Sorin J.

AU - Genereux, Philippe

AU - Kornowski, Ran

AU - Dudek, Dariusz

AU - Gersh, Bernard J.

AU - Stone, Gregg W.

PY - 2014/4/15

Y1 - 2014/4/15

N2 - Statin therapy is indicated after ST-segment elevation myocardial infarction (STEMI) to reduce recurrent ischemic events, but approximately 6% of patients with STEMI do not receive a statin prescription at discharge. This substudy aimed to define the clinical outcomes and patient characteristics associated with statin nonprescription after STEMI. We compared clinical, angiographic, and procedural characteristics and in-hospital, 30-day, 1-year, 2-year, and 3-year outcomes in 3,512 patients discharged after STEMI with and without (6%) statin prescriptions in the harmonizing outcomes with revascularization and stents in acute myocardial infarction trial (www.clinicaltrials.gov, NCT00433966). Statin nonprescription was associated with female sex, nonwhite race, previous bypass surgery, heart failure, renal impairment, anemia, thrombocytopenia, care in the United States, lower prescription rates of antiplatelets and neurohormonal antagonists, less percutaneous coronary intervention and stents, and, in 26% of cases, angiographically normal or nonobstructed coronary arteries. At every time point of follow-up after discharge, patients with no discharge statin prescription had significantly higher rates of net adverse clinical events, major adverse cardiac events, major bleeding unrelated to bypass surgery, and death. After multivariable adjustment, absence of a discharge statin prescription independently predicted 3-year major adverse cardiac event (hazard ratio 1.54, 95% confidence interval 1.15 to 2.07, p = 0.0037) and death (hazard ratio 2.30, 95% confidence interval 1.41 to 3.77, p = 0.0009). In conclusion, within the framework of this randomized trial of patients presenting with STEMI, approximately 6% of patients were discharged without statin therapy. Absence of a discharge statin prescription after STEMI was an independent predictor of ischemic events including death.

AB - Statin therapy is indicated after ST-segment elevation myocardial infarction (STEMI) to reduce recurrent ischemic events, but approximately 6% of patients with STEMI do not receive a statin prescription at discharge. This substudy aimed to define the clinical outcomes and patient characteristics associated with statin nonprescription after STEMI. We compared clinical, angiographic, and procedural characteristics and in-hospital, 30-day, 1-year, 2-year, and 3-year outcomes in 3,512 patients discharged after STEMI with and without (6%) statin prescriptions in the harmonizing outcomes with revascularization and stents in acute myocardial infarction trial (www.clinicaltrials.gov, NCT00433966). Statin nonprescription was associated with female sex, nonwhite race, previous bypass surgery, heart failure, renal impairment, anemia, thrombocytopenia, care in the United States, lower prescription rates of antiplatelets and neurohormonal antagonists, less percutaneous coronary intervention and stents, and, in 26% of cases, angiographically normal or nonobstructed coronary arteries. At every time point of follow-up after discharge, patients with no discharge statin prescription had significantly higher rates of net adverse clinical events, major adverse cardiac events, major bleeding unrelated to bypass surgery, and death. After multivariable adjustment, absence of a discharge statin prescription independently predicted 3-year major adverse cardiac event (hazard ratio 1.54, 95% confidence interval 1.15 to 2.07, p = 0.0037) and death (hazard ratio 2.30, 95% confidence interval 1.41 to 3.77, p = 0.0009). In conclusion, within the framework of this randomized trial of patients presenting with STEMI, approximately 6% of patients were discharged without statin therapy. Absence of a discharge statin prescription after STEMI was an independent predictor of ischemic events including death.

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