Effect of Intensive Statin Therapy on Clinical Outcomes Among Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

• Published in: Journal of the American College of Cardiology Vol. 54; no. 24; pp. 2290 - 2295
• Main Authors: Gibson, C. Michael, MS, MD, Pride, Yuri B., MD, Hochberg, Claudia P., MD, Sloan, Sarah, MA, MS, Sabatine, Marc S., MD, MPH, Cannon, Christopher P., MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.12.2009
• Subjects: acute coronary syndrome; Cardiovascular; Internal Medicine; percutaneous coronary intervention; pleiotropic; statin; CRP; C-reactive protein; OR; LDL-C; CI; low-density lipoprotein cholesterol; myocardial infarction; HR; odds ratio; pleiotropic; ACS; TVR; percutaneous coronary intervention; acute coronary syndrome; statin; PCI; hazard ratio; target vessel revascularization; confidence interval; CABG; MI; coronary artery bypass grafting
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.09.010

Objectives The goal of this analysis was to determine whether intensive statin therapy, compared with moderate-dose statin therapy, leads to a reduction in major adverse cardiovascular events (MACE) among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Background When compared with moderate-dose statins, intensive statin therapy reduces MACE among patients with ACS. The role of intensive statin therapy specifically among patients who undergo PCI for ACS is unknown. Methods Outcomes were compared in 2,868 patients who underwent PCI for ACS just prior to enrollment in the PROVE IT–TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22) trial, which randomized patients to either atorvastatin 80 mg or pravastatin 40 mg daily. The incidence of the primary composite end point of all-cause mortality, myocardial infarction, unstable angina leading to hospitalization, and revascularization after 30 days and stroke was evaluated, as was the incidence of target vessel revascularization (TVR) and non-TVR during follow-up. Results Treatment with 80 mg atorvastatin reduced the incidence of the composite end point (21.5% vs. 26.5%, hazard ratio: 0.78, 95% confidence interval: 0.67 to 0.91, p = 0.002) and lowered the incidence of both TVR (11.4% vs. 15.4%, p = 0.001) and non-TVR (8.0% vs. 10.5%, p = 0.017) compared with 40 mg pravastatin. After adjusting for on-treatment serum low-density lipoprotein cholesterol and C-reactive protein concentrations, the odds of TVR with high-dose statin therapy remained significant (odds ratio: 0.74, p = 0.015) while the odds of non-TVR did not (odds ratio: 0.92, p = 0.55). Conclusions Among patients with ACS who undergo PCI, intensive statin therapy reduces MACE compared with moderate-dose statin therapy. The reduction in the incidence of TVR was independent of low-density lipoprotein cholesterol and C-reactive protein lowering and may therefore be due, at least in part, to a pleiotropic effect of high-dose statin therapy. (PROVE IT–TIMI 22; NCT00382460 )