title: Statin therapy and clinical outcomes in myocardial infarction patients complicated by acute heart failure: insights from the EPHESUS trial.
abstract: OBJECTIVE
  Several clinical trials have shown that in patients with acute myocardial infarction (MI), statin therapy improves cardiovascular (CV) outcomes, but in these trials patients with acute heart failure (HF) were excluded or only a few were included. In patients with chronic HF, statin therapy does not reduce all-cause or CV mortality. We aimed to assess the association between statin therapy and clinical outcomes in the setting of acute HF with systolic dysfunction complicating acute MI.
  
  
  RESULTS
  We performed a post-hoc analysis in 6632 patients included in the EPHESUS trial. The mean age of patients was 64 years and 71% were male. Overall, 47% of patients had a statin prescribed at baseline. Cox regression models and a secondary analysis using propensity score matching were fit to assess the association between statin prescription and clinical outcomes. During a mean follow-up of 16 ± 7 months, all-cause death occurred in 385 (12%) patients with and in 647 (18%) patients without a statin (P < 0.001). After extensive adjustment, the risk of all-cause death was 20% lower in patients on statin [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.69-0.92, P = 0.001]. This positive association was mostly due to a lower risk of CV death (HR 0.76, 95% CI 0.65-0.88, P = 0.0002). In contrast, statin use was associated with a higher risk of non-CV hospitalizations (HR 1.16, 95% CI 1.02-1.33, P = 0.02).
  
  
  CONCLUSIONS
  Our results suggest that patients with acute HF complicating acute MI may benefit from being on statin therapy. Prospective clinical trials are required to validate these findings.
authors.affiliation: INSERM, Center of Clinical Investigation 9501, Lorraine Institute of Heart and Vessels Louis Mathieu, University Hospital Nancy, France. d.dobre@chu-nancy.fr
authors.forename: Daniela
authors.initials: D
authors.lastname: Dobre
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Jan
authors.initials: J
authors.lastname: Murin
authors.forename: Alexander
authors.initials: A
authors.lastname: Parkhomenko
authors.forename: Zohra
authors.initials: Z
authors.lastname: Lamiral
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D000208:Acute Disease; D000368:Aged; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D000077545:Eplerenone; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D057216:Propensity Score; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone