Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention

Chan, Albert W.; Bhatt, Deepak L.; Chew, D.; Quinn, MJ; Molterno, David J.; Topol, Eric J.; Ellis, Stephen G.

doi:10.1016/s0735-1097(02)80067-5

Cited by 60 publications

(78 citation statements)

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“…Patients are then matched on the propensity score, thereby creating an equivalent treatment and control group. 10,11 We used this method to assign a propensity score to each patient, representing the relationship between undergoing a transfusion and the demographic, historical, in-hospital risk factors and outcomes included in the logistic regression model. The score was then used to match transfused anemic patients to nontransfused anemic patients by employing a greedy matching protocol (available at: http://www2.sas.com/proceedings/sugi26/p214-26.pdf).…”

Section: Propensity Matchingmentioning

confidence: 99%

Blood Transfusion and In-hospital Outcomes in Anemic Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Jani

Smith

et al. 2007

Clin Cardiol

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SummaryStudies have shown poor prognostic implications of anemia in patients with myocardial infarction (MI) and in patients undergoing percutaneous coronary intervention (PCI). The impact of blood transfusion in these populations remains controversial. The objective of this study was to examine the effect of transfusion on in-hospital mortality in anemic patients undergoing PCI for MI.Data from 67,051 PCIs (June 1, 1997 to January 31, 2004) were prospectively collected in a multicenter registry (Blue Cross Blue Shield of Michigan Cardiovascular Consortium). Of these, 4,623 patients who were classified as anemic according to the World Health Organization criteria underwent PCI within 7 days of presentation with acute MI. A propensity score for being transfused was estimated for each patient, and propensity matching and a prediction model for in-hospital death were developed.The average age was 67.8 years, 57.7% of patients were men, and 22.3% of patients received a transfusion during hospitalization. Transfused patients, compared to nontransfused patients, were more likely to be older, female, have lower preprocedure hemoglobin levels, more comorbidities, and a higher unadjusted in-hospital mortality rate (14.52% vs. 3.01%, p < 0.0001). After adjustment for comorbidities and propensity for transfusion, blood transfusion was associated with a higher risk of in-hospital mortality (adjusted odds ratio = 2.02, 95% confidence interval 1.47-2.79, p < 0.0001).In anemic patients undergoing PCI for MI, transfusion was associated with an increased crude and adjusted rate of in-hospital mortality. A randomized controlled trial is needed to determine the value of transfusion and the ideal transfusion criteria.

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Section: Propensity Matchingmentioning

confidence: 99%

Blood Transfusion and In-hospital Outcomes in Anemic Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Jani

Smith

et al. 2007

Clin Cardiol

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“…This is encouraging in light of the growing evidence for early in-hospital initiation and the broader benefit of lipidlowering therapy (6,7). More specifically, emerging data in the PCI population continues to substantiate the advantage of the pleiotropic properties of statin therapy in these patients (10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…effects of statins, while plaque progression may be further reduced by inhibition of vascular smooth muscle cell proliferation (9). The favourable effects that statins have on platelet adhesion, thrombosis, endothelial function, inflammation and plaque stability have been shown to reduce cardiovascular morbidity and mortality, and possibly restenosis, after percutaneous coronary intervention (PCI) (10)(11)(12)(13)(14). In-hospital initiation of lipid-lowering therapy, when patients are focused on their cardiovascular risk and health care professionals are present to facilitate patient education, may in turn strengthen the perception that this therapy is essential for the prevention of recurrent events and may improve adherence to drug regimens (15,16).…”

Section: Methods: Patients Undergoing a First Pci Between August 2000mentioning

confidence: 99%

“…Contrary to past management, when PCI and medical therapy had been considered as alternate, competing strategies for symptomatic CAD (18,19), lipid-lowering therapy is now seen as providing early, complementary benefit in combination with coronary revascularization. However, in a recent survey, only 26.5% of 5052 patients undergoing PCI were receiving statin treatment at the time of the procedure (10).…”

Section: Methods: Patients Undergoing a First Pci Between August 2000mentioning

confidence: 99%

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The use of lipid-lowering therapy for secondary prevention in patients undergoing percutaneous coronary intervention

Jessica

Jackevicius

Genus

et al. 2006

Canadian Journal of Cardiology

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“…Essas modificações se relacionaram significantemente às taxas lipídicas anteriores e posteriores a administração de fluvastatina. Os resultados do LIPS tornam válidos os achados de análise de subgrupos do estudo CARE 44 e de estudos não randomizados realizados a curto prazo e após a implantação de stent em artérias coronárias que revelaram sobrevida maior sem infarto do miocárdio, menor necessidade de novo procedimento de revascularização e menor mortalidade 24,45,46 .…”

Section: A -Estudos Controlados Por Angiografiaunclassified

Vastatinas na prevenção da doença aterosclerótica: dados atuais

Forti¹,

Diament²

2004

Arq. Bras. Cardiol.

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264 nose e não melhorou significantemente os outros parâmetros angiográficos 16,[18][19][20]25 . Resultados alentadores foram obtidos após a implantação de "stents" em estudos não randomizados 26 . B -Estudos controlados por métodos não invasivos 27-32Ultra-sonografia e, mais recentemente, ressonância magnética de alta resolução têm sido empregadas para avaliar a ação das vastatinas na aterosclerose das artérias carotídeas. Redução da espessura íntima-média dessas artérias foi observada em pacientes assintomáticos (lovastatina 20-40 mg/dL, sinvastatina 20-40 mg/ dL), em coronariopatas (pravastatina 20-40 mg/dL) e em portadores de hipercolesterolemia familiar (atorvastatina 80 mg/dL). C -Estudos clínicos prospectivosForam realizados em grupos populacionais sem (prevenção primária) e com (prevenção secundária) manifestações de doença arterial coronariana (DAC) e em grupos especiais. 33 acompanhou por seis anos 6.595 homens (95% sem manifestação anterior de doença arterial coronariana) de 45 a 64 anos (média = 55 anos) com colesterolemia média de 272mg/dl; 3.302 homens receberam pravastatina (40mg/dia) e apresentaram redução de colesterol total -CT (-20%), de LDL-c -colesterol ligado à lipoproteína de baixa densidade -(-26%) e aumento de colesterol ligado à lipoproteína de alta densidade -HCL-c (-5%); em relação aos controles, exibiram reduções estatisticamente significantes de infarto do miocárdio não fatal (-31%), mortalidade por todas as causas cardiovasculares (-32%), necessidade de coronariografia (-31%) e realização de procedimentos invasivos (-37%). Embora sem significância estatística, apresentaram: redução de mortes por doença arterial coronariana (-28%), de mortalidade por causas não cardiovasculares (-11%), de mortalidade total (-22%), de mortalidade por neoplasias (-11%), incidência menor de acidentes vasculares cerebrais fatais e não fatais (-11%) e incidência maior de câncer (+8%). Após ajuste em relação a outros fatores de risco, verificou-se diminuição significativa da mortalidade total (-24%) As vastatinas inibem a síntese intracelular do colesterol, estimulam a formação dos receptores de LDL (lipoproteína de baixa densidade), agem sobre mediadores vaso-ativos, melhorando a função endotelial, diminuem a ativação e agregação plaquetária, possuem efeitos anti-inflamatórios e anti-oxidantes, inibem a migração e proliferação de células musculares lisas e a formação de células espumosas, estabilizam a placa aterosclerótica 1,2 . Com essas propriedades, aliadas à eficácia, segurança e tolerância, são hoje consideradas fármacos de primeira escolha na terapêu-tica da hipercolesterolemia, fator de risco primordial para o desenvolvimento e evolução da doença aterosclerótica 3 . Benefíci-os do tratamento na prevenção desta entidade nosológica têm sido demonstrados em estudos controlados por métodos invasivos (angiografia) ou não (ultra-sonografia, ressonância magnética) ou em estudos clínicos prospectivos que avaliaram grandes populações ou grupos especiais. C.1 -Prevenção primária - A -Estudos controlados...

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Early and sustained survival benefit associated with statin therapy at the time of percutaneous coronary intervention

Cited by 60 publications

References 0 publications

Blood Transfusion and In-hospital Outcomes in Anemic Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Blood Transfusion and In-hospital Outcomes in Anemic Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

The use of lipid-lowering therapy for secondary prevention in patients undergoing percutaneous coronary intervention

Vastatinas na prevenção da doença aterosclerótica: dados atuais

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