title: Impact of postdischarge statin withdrawal on long-term outcomes in patients with acute myocardial infarction.
abstract: Many patients discontinue statin after acute myocardial infarction (AMI) despite its necessity. However, limited data are available describing the clinical impact of statin withdrawal after AMI. This study enrolled 3,807 patients in the Korean multicenter registry who survived for 1 year after AMI. All patients were prescribed statin at discharge and were divided into 2 groups on the basis of statin withdrawal history; 603 patients had a history of statin discontinuation and 3,204 patients continued statin therapy. The primary outcome was mortality from any cause. We also analyzed the incidence of cardiac death, nonfatal myocardial infarction, any revascularization, and stroke. The duration of follow-up was 4 years after AMI. Statin withdrawal was associated with higher mortality than continued statin treatment (hazard ratio 3.45, 95% confidence interval 2.81 to 4.24, p <0.001), primarily as the result of increased cardiac mortality (hazard ratio 4.65, 95% confidence interval 3.14 to 6.87, p <0.001). However, the incidences of nonfatal myocardial infarction, any revascularization, and stroke were not different between the groups. Analysis by propensity score matching did not affect the results. In conclusion, many patients experienced statin withdrawal after AMI, which significantly increased long-term mortality in the present study. Careful education and monitoring are needed to reduce adverse cardiac outcomes in patients after AMI.
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Hae Chang
authors.initials: HC
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Keun Ho
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Yoon
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Cardiology, Cardiovascular Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Department of Cardiology, Cardiovascular Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.affiliation: Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea. Electronic address: cecilyk@hanmail.net.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
mesh_terms: D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010351:Patient Discharge; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000639:trends*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors