title: Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear.
  
  
  RESULTS
  We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138]  mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI.
  
  
  CONCLUSIONS
  In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN mdm307@mail.harvard.edu.|Minneapolis Heart Institute, Minneapolis, MN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Miedema
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.
authors.forename: Lucas J
authors.initials: LJ
authors.lastname: Schnaidt
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.
authors.forename: Erin
authors.initials: E
authors.lastname: Peterson
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.|Minneapolis Heart Institute, Minneapolis, MN.
authors.forename: Craig
authors.initials: C
authors.lastname: Strauss
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.|Minneapolis Heart Institute, Minneapolis, MN.
authors.forename: Scott
authors.initials: S
authors.lastname: Sharkey
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.|Minneapolis Heart Institute, Minneapolis, MN.
authors.forename: Thomas
authors.initials: T
authors.lastname: Knickelbine
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.|Minneapolis Heart Institute, Minneapolis, MN.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Newell
authors.affiliation: Minneapolis Heart Institute Foundation, Minneapolis, MN.|Minneapolis Heart Institute, Minneapolis, MN.|Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D017723:Drug Utilization Review; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004608:Eligibility Determination; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides
keywords: ST‐segment elevation myocardial infarction; cholesterol; prevention; statin