title: Statin therapy in patients with chronic kidney disease undergoing percutaneous coronary intervention (from the Evaluation of Drug Eluting Stents and Ischemic Events Registry).
abstract: Secondary prevention trials have demonstrated the efficacy of statins in reducing cardiovascular morbidity and mortality in patients with coronary artery disease and events after percutaneous coronary intervention (PCI). However, there are few data describing the clinical value of statins in patients with coronary artery disease and chronic kidney disease (CKD) undergoing PCI. Of 10,148 patients who entered into Evaluation of Drug Eluting Stents and Ischemic Events, a multicenter registry of unselected patients undergoing PCI from July 2004 to December 2007, we studied 2,306 patients with CKD (estimated glomerular filtration rate ≤60 ml/min based on the Modified Diet in Renal Disease calculation). Patients were stratified into those receiving statins at discharge (n = 1,833, 79%) or not (n = 473, 21%). Patients in the statin group had a greater prevalence of hypertension, recent myocardial infarction (MI), and use of β blockers and angiotensin-converting enzyme inhibitors. Outcomes were assessed from discharge through 1-year follow-up. One-year all-cause mortality was 5.7% in statin group versus 8.7% in the no statin group (adjusted hazard ratio 0.55, 95% confidence interval 0.34 to 0.88). The composite of death, MI, and repeat revascularization was lower in statin group (adjusted hazard ratio 0.71, 95% confidence interval 0.51 to 0.99). In conclusion, among patients with CKD undergoing PCI, the prescription of statins at hospital discharge was associated with a significant improvement in subsequent outcomes including mortality and composite end point of death, MI, and repeat revascularization.
authors.affiliation: Department of Internal Medicine, Cardiology Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address: dasaritarun@gmail.com.
authors.forename: Tarun W
authors.initials: TW
authors.lastname: Dasari
authors.affiliation: Department of Internal Medicine, Cardiology Section, St Luke's Mid America Heart Institute, Kansas City, Kansas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Department of Internal Medicine, Cardiology Section, Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.affiliation: Harvard Clinical Research Institute, Boston, Massachusetts.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Keyes
authors.affiliation: Harvard Clinical Research Institute, Boston, Massachusetts.
authors.forename: Chen-Hsing
authors.initials: CH
authors.lastname: Yen
authors.affiliation: Department of Internal Medicine, Cardiology Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Elias B
authors.initials: EB
authors.lastname: Hanna
authors.affiliation: NorthShore University Health System, Evanston, Illinois.
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Saucedo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors