Favourable effect of statin therapy on early survival benefit at the time of percutaneous coronary intervention for ST-elevation myocardial infarction and shock.
OBJECTIVE
Long-term administration of statin therapy has been shown to reduce major coronary events and cardiac mortality within randomised clinical trials. Statins favourably affect platelet adhesion, thrombosis, endothelial function, inflammation, plaque stability, and ventricular arrhythmia, which may potentially improve outcome after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) and shock. Therefore, we hypothesised that statin therapy has an early beneficial effect among patients undergoing PCI for STEMI complicated by cardiogenic shock.


RESULTS
We retrospectively collected data of consecutive patients undergoing emergency PCI for STEMI complicated by cardiogenic shock between January 2000 and June 2008. Baseline, procedural, and in-hospital data of statin-treated and non-statin-treated patients were compared. Propensity score and multivariate survival analysis were used to adjust for heterogeneity between the two groups. Of 111 patients who comprised the study population, 30/111 (27%) were treated with statin at the time of the procedure. Statin therapy was associated with an in-hospital mortality reduction (46.7% versus 70.4%; odds ratio, 0.32; 95% CI, 0.11-0.89; P=0.029). After adjusting for the propensity to receive statin therapy before the procedure and other confounders, statin therapy remained an independent predictor for in-hospital survival after coronary intervention (odds ratio, 0.35; 95% CI, 0.15 to 0.88; P=0.026).


CONCLUSIONS
In this study cohort, statin therapy among patients undergoing emergency PCI for STEMI and cardiogenic shock is associated with a significant mortality advantage at early follow-up.
Garot
Philippe
P
Institut Cardiovasculaire Paris Sud, Quincy and Massy, France. p.garot@angio-icps.com
Bendaoud
Nabil
N
Lefèvre
Thierry
T
Morice
Marie-Claude
MC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors