Effect of Statin Treatment and Low-Density Lipoprotein-Cholesterol on Short-Term Mortality in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention - Multicenter Registry From Tokyo CCU Network Database

Mizuki Miura, Masao Yamasaki, Yukari Uemura, Masatomo Yoshikawa, Katsumi Miyauchi, Hiroyuki Tanaka, Hideki Miyachi, Jun Yamashita, Makoto Suzuki, Takeshi Yamamoto, Ken Nagao, Issei Komuro, Morimasa Takayama
Circulation Journal: Official Journal of the Japanese Circulation Society 2016, 80 (2): 461-8

BACKGROUND: Previous trials have found that low low-density lipoprotein-cholesterol (LDL-C) on admission was associated with increased mortality in patients with acute myocardial infarction (AMI). There are few reports, however, on the effect of low LDL-C with or without in-hospital statin treatment on short-term prognosis in AMI patients.

METHODS AND RESULTS: A total of 9,032 AMI patients underwent primary PCI in 68 centers in the Tokyo CCU Network Registry during 2009-2012, in whom LDL-C was measured in 6,486. We divided them into 4 groups: statin-treated/LDL-C <100 mg/dl (n=1,236), statin-treated/LDL-C ≥ 100 mg/dl (n=3,671), statin-naïve/LDL-C <100 mg/dl (n=662), and statin-naïve/LDL-C ≥ 100 mg/dl (n=917). We assessed hospital mortality within 30 days. In-hospital all-cause mortality was significantly lower in the statin-treated/LDL-C ≥ 100-mg/dl group (3.2%, P<0.001). On multivariate Cox regression analysis, adjusted for age, gender, hypertension, diabetes mellitus, dyslipidemia and other clinical factors, the combination of statin treatment and LDL-C ≥ 100 mg/dl was an independent predictor of lower in-hospital mortality (adjusted HR, 0.211; 95% CI: 0.096-0.462; P<0.001). In the LDL-C <100-mg/dl patients, statin treatment also independently reduced in-hospital mortality (adjusted HR, 0.467; 95% CI: 0.223-0.976; P=0.043). Spontaneously low LDL-C was associated with increased short-term mortality.

CONCLUSIONS: Statin treatment was associated with better short-term outcome in patients with AMI, even in patients with low LDL-C.

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