title: Association between statin treatment and LDL-cholesterol levels on the rate of ST-elevation myocardial infarction among patients with acute coronary syndromes: ACS Israeli Survey (ACSIS) 2002-2010.
abstract: BACKGROUND
  STEMI is thought to occur as a result of a vulnerable coronary plaque rupture. Statins possess hypolipidemic and pleotropic effects that stabilize coronary plaque. We sought to determine the association between LDL-C levels, statin use prior to the index event on the type of acute coronary syndrome (ACS) presentation: STEMI vs. non-STEMI/unstable angina.
  
  
  METHODS
  Data was drawn from the ACS Israeli Survey (ACSIS), a biennial prospective survey of ACS patients hospitalized in all CCU/Cardiology departments during 2002-2010.
  
  
  RESULTS
  Among 6790 patients, 2760 (41%) reported statin use prior to the index ACS event. The proportion of STEMI was significantly lower among statin treated vs. statin naive patients (36% vs. 57%, p<0.0001). At each LDL-C level, the proportion of STEMI was significantly lower only among statin treated patients (p<0.0001). LDL-C<70 mg/dL was associated with a lower proportion of STEMI only among statin treated but not among statin naive patients (33% vs. 57%, p<0.0001). Multivariate analysis revealed that statin use was independently associated with a lower probability of presenting with STEMI (ORadj=0.73, p=0.007), but not LDL-C<70 mg/dL (ORadj=1.13, p=0.32). Patients on high-intensity statin therapy (HIST) were less likely to present with STEMI as compared with low-intensity statin therapy (LIST) or statin naive patients (27%, 38%, 56%, respectively, p for trend <0.0001; HIST ORadj=0.28, p=0.01; LIST ORadj=0.48, p=0.026).
  
  
  CONCLUSIONS
  Among patients admitted with ACS, statin use but not LDL-C level, was associated with a lower probability of presenting with STEMI. Patients on HIST had the lowest likelihood of presenting with STEMI.
authors.affiliation: Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel; Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. Electronic address: shmuelg@ekmd.huji.ac.il.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.affiliation: Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Kolker
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.affiliation: Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Leitersdorf
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Tzivoni
authors.affiliation: Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Mady
authors.initials: M
authors.lastname: Moriel
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute coronary syndrome; LDL-C; ST-elevation myocardial infarction; Statins