Withdrawal of Statins Increases Event Rates in Patients With Acute Coronary Syndromes

Heeschen, Christopher; Hamm, Christian W.; Laufs, Ulrich; Snapinn, Steven; Böhm, Michael; White, Harvey D.

doi:10.1161/01.cir.0000012530.68333.c8

Cited by 441 publications

(204 citation statements)

References 33 publications

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“…This might relate to recent reports on the detrimental effect of statin withdrawal in patients with acute coronary syndromes and the early and sustained postprocedural clinical benefit for patients receiving statin treatment before PCI. 6,16 In line with these findings are the current results of a 56% lower incidence of death/AMI among patients with preprocedural statin therapy during follow-up (2.4% versus 5.4%), which did not reach significance level because of the overall small number of cases. Thus, preprocedural statin therapy might improve postprocedural clinical outcome by reducing periprocedural AMI.…”

Section: Clinical Implicationmentioning

confidence: 54%

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

et al. 2002

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Background-Stenting-related myocardial injury has been recognized as a frequent and prognostically important event, the extent of which depends on microcirculatory impairment in association with platelet aggregation, inflammation, and increased oxidative stress. Recent studies underscored the non-lipid-lowering effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) with antithrombotic, antiinflammatory, and antioxidative aspects. Thus, we tested the hypothesis that preprocedural statin therapy is associated with a reduction in the extent of stenting-related myocardial injury. Methods and Results-We stratified 296 consecutive patients who were undergoing stenting of a de novo stenosis according to the preprocedural status of statin therapy (229 statin-treated and 67 control patients). Incidence of periprocedural myocardial injury was assessed by analysis of creatine kinase (CK; upper limit of normal [ULN] 70 IU/L for women, 80 IU/L for men) and cardiac troponin T (cTnT; bedside test; threshold 0.1 ng/mL) before and 6, 12, and 24 hours after the intervention. Relative to control patients, the incidence of CK elevation Ͼ3ϫ ULN was more than 90% lower in statin-treated patients (0.4% versus 6.0%, Pϭ0.01). Statin therapy was the only factor independently associated with a lower risk of CK elevation Ͼ3ϫ ULN (OR: 0.08, 95% CI: 0.01 to 0.75; Pϭ0.03). The overall incidences of CK and cardiac troponin T elevation were slightly lower in statin-treated than in control patients (14.4% versus 20.9%, Pϭ0.3, and 17.9% versus 22.4%, Pϭ0.5, respectively). Conclusions-Preprocedural statin therapy is associated with a reduction in the incidence of larger-sized, stenting-related myocardial infarctions. Prospective, randomized trials are warranted to further assess this cardioprotective effect of statins in coronary intervention.

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Section: Clinical Implicationmentioning

confidence: 54%

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

et al. 2002

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“…Exposure to statins in the acute phase of experimental stroke appears to promote angiogenesis and synaptogenesis,15 and additional pleiotropic statin effects such as vasodilatory and antithrombotic properties have been reported 16. These experimental observations are supported by clinical findings of improved outcomes with acute statin use in myocardial infarction,17, 18, 19 stroke,3, 4, 20, 21 and major vascular surgery 22, 23…”

Section: Discussionmentioning

confidence: 87%

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

Flint

Conell

Klingman

et al. 2016

JAHA

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BackgroundStatin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization.Methods and ResultsThis is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an “opt‐in” to “opt‐out” mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time‐series modeling. The EMR intervention increased both overall in‐hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [P diff]=0.02, P=0.016) and discharge to home or rehabilitation facility (P diff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (P diff=0.17, P=0.033) and rate of discharge to home or rehabilitation (P diff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in‐hospital (P diff=−0.14, P=0.026).ConclusionsA simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.

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“…Another weakness is the differential perioperative atorvastatin dosing regimen for long‐term statin users and statin‐naïve patients, which could introduce potential bias into our assessment of long‐term statin effect on the association between HDL concentration and postoperative AKI and imprecision into our analysis of the effects of atorvastatin. To minimize patient risk, the parent trial only withheld statin use from long‐term statin‐using patients (administered placebo) on days in which statins would be withheld in usual clinical care, specifically the day of surgery and postoperative day 1, because the evidence at trial design suggested that statin withdrawal at surgery could be harmful 41, 42, 43, 44. Fortunately, the effect of perioperative atorvastatin on the association between HDL cholesterol concentration and ΔSCr can be accurately assessed, because patients were randomly assigned to perioperative placebo or atorvastatin treatment.…”

Section: Discussionmentioning

confidence: 99%

High‐Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Smith

Blume

Linton

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased short‐ and long‐term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High‐density lipoproteins (HDLs) have anti‐inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti‐inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association.Methods and ResultsWe tested our hypothesis in 391 subjects from a randomized clinical trial of perioperative atorvastatin to reduce AKI after cardiac surgery. A 2‐component latent variable mixture model was used to assess the association between preoperative HDL cholesterol concentration and postoperative change in serum creatinine, adjusted for known AKI risk factors and suspected confounders. Interaction terms were used to examine the effects of preoperative statin use, preoperative statin dose, and perioperative atorvastatin treatment on the association between preoperative HDL and AKI. A higher preoperative HDL cholesterol concentration was independently associated with a decreased postoperative serum creatinine change (P=0.02). The association between a high HDL concentration and an attenuated increase in serum creatinine was strongest in long‐term statin‐using patients (P=0.008) and was further enhanced with perioperative atorvastatin treatment (P=0.004) and increasing long‐term statin dose (P=0.003).ConclusionsA higher preoperative HDL cholesterol concentration was associated with decreased AKI after cardiac surgery. Preoperative and perioperative statin treatment enhanced this association, demonstrating that pharmacological potentiation is possible during the perioperative period.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00791648.

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Withdrawal of Statins Increases Event Rates in Patients With Acute Coronary Syndromes

Cited by 441 publications

References 33 publications

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

High‐Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

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