The influence of early statin administration on in-hospital and 1-year mortality after acute coronary syndrome: experience from the Croatian branch of the ISACS-CT registry

    Authors

    Keywords

    acute coronary syndrome, statins, mortality

    DOI

    https://doi.org/10.15836/ccar2018.301

    Full Text

    Background and Aim: The relevance of statin therapy in acute coronary syndrome (ACS) is well-established, but little is known about the optimal timing of statin administration, particularly within the first 24 hours following ACS. ( 1 , 2 ) The aim of the study was to gather data on early and late outcomes of ACS patients (pts) through the Croatian branch of the ISACS-CT (International Registry of Acute Coronary Syndromes in Transitional Countries) registry. Patients and Methods: The data was gathered retrospectively from January 2012 to October 2017. The study population included 1898 ACS pts: 46.4% (n=881) with ST-segment elevation myocardial infarction (STEMI), 36.1% (n=685) with non-ST-segment elevation myocardial infarction (NSTEMI) and 17.5% (n=332) with unstable angina pectoris (UA). Follow-up was performed on 33% (n=630) of the cohort, 43.7% (n=275) with STEMI, 34.4% (n=217) NSTEMI and 21.9% (n=138) with UA. Results: In the first 24 hours following ACS, statins were administered in 1734 (93%) pts (for 24 pts the data is missing), while the pts who received them later or not at all were the control group. The two groups did not differ regarding age, gender, body mass index, left ventricular ejection fraction (LVEF) during initial hospitalization, smoking status, history of diabetes, chronic heart failure or arterial hypertension at initial hospitalization nor at 1-year follow-up ( Table 1 ). The overall in-hospital mortality rate was 4%, similar to that in pts treated with statins within the first 24 hours (3%), while in pts without early statin treatment, in-hospital mortality rate was 18% (p<0.001). The risk of in-hospital death was significantly higher in pts without early statin therapy (odds ratio [OR] 7.32, 95% confidence interval [CI] 4.371-12.27, p<0.001), while the risk of primary outcome at 1-year follow-up was not significantly different between groups in univariate regression analysis. Older age (OR 1.1, 95% CI 1.06-1.20, p< 0.001), higher creatinine level (OR 1.0, 95% CI 1.005-1.012, p<0.001), lower LVEF (OR 0.90, 95%CI 0.86-0.94, p<0.001) and lack of early statin treatment (OR 3.6, 95% CI 1.0-13.10, p=0.05) were positively associated with increased odds for early primary outcome in multivariable regression model ( Table 2 ). Conclusion: Initiation of statin therapy within the first 24 hours following ACS is associated with a significant reduction in in-hospital mortality, although the positive effect of early statin therapy did not reach statistical significance at 1-year follow-up.

    Cardiologia Croatica
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    The influence of early statin administration on in-hospital and 1-year mortality after acute coronary syndrome: experience from the Croatian branch of the ISACS-CT registry

    Extended Abstract
    Issue11-12
    Published
    Pages301-302
    PDF via DOIhttps://doi.org/10.15836/ccar2018.301
    acute coronary syndrome
    statins
    mortality

    Authors

    Dora Fabijanović*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Filip LončarićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Petra MjehovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dorja SabljakORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Antonija MiškovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dominik OrozORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ines VinkovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedrana VlahovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Grgur SalaiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Saša PavasovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Background and Aim: The relevance of statin therapy in acute coronary syndrome (ACS) is well-established, but little is known about the optimal timing of statin administration, particularly within the first 24 hours following ACS. ( 1 , 2 ) The aim of the study was to gather data on early and late outcomes of ACS patients (pts) through the Croatian branch of the ISACS-CT (International Registry of Acute Coronary Syndromes in Transitional Countries) registry. Patients and Methods: The data was gathered retrospectively from January 2012 to October 2017. The study population included 1898 ACS pts: 46.4% (n=881) with ST-segment elevation myocardial infarction (STEMI), 36.1% (n=685) with non-ST-segment elevation myocardial infarction (NSTEMI) and 17.5% (n=332) with unstable angina pectoris (UA). Follow-up was performed on 33% (n=630) of the cohort, 43.7% (n=275) with STEMI, 34.4% (n=217) NSTEMI and 21.9% (n=138) with UA. Results: In the first 24 hours following ACS, statins were administered in 1734 (93%) pts (for 24 pts the data is missing), while the pts who received them later or not at all were the control group. The two groups did not differ regarding age, gender, body mass index, left ventricular ejection fraction (LVEF) during initial hospitalization, smoking status, history of diabetes, chronic heart failure or arterial hypertension at initial hospitalization nor at 1-year follow-up ( Table 1 ). The overall in-hospital mortality rate was 4%, similar to that in pts treated with statins within the first 24 hours (3%), while in pts without early statin treatment, in-hospital mortality rate was 18% (p<0.001). The risk of in-hospital death was significantly higher in pts without early statin therapy (odds ratio [OR] 7.32, 95% confidence interval [CI] 4.371-12.27, p<0.001), while the risk of primary outcome at 1-year follow-up was not significantly different between groups in univariate regression analysis. Older age (OR 1.1, 95% CI 1.06-1.20, p< 0.001), higher creatinine level (OR 1.0, 95% CI 1.005-1.012, p<0.001), lower LVEF (OR 0.90, 95%CI 0.86-0.94, p<0.001) and lack of early statin treatment (OR 3.6, 95% CI 1.0-13.10, p=0.05) were positively associated with increased odds for early primary outcome in multivariable regression model ( Table 2 ). Conclusion: Initiation of statin therapy within the first 24 hours following ACS is associated with a significant reduction in in-hospital mortality, although the positive effect of early statin therapy did not reach statistical significance at 1-year follow-up.