TY - JOUR
T1 - Temporal trends, determinants, and impact of high-intensity statin prescriptions after percutaneous coronary intervention
T2 - Results from a large single-center prospective registry
AU - Guedeney, Paul
AU - Baber, Usman
AU - Claessen, Bimmer
AU - Aquino, Melissa
AU - Camaj, Anton
AU - Sorrentino, Sabato
AU - Vogel, Birgit
AU - Farhan, Serdar
AU - Faggioni, Michela
AU - Chandrasekhar, Jaya
AU - Kalkman, Deborah N.
AU - Kovacic, Jason C.
AU - Sweeny, Joseph
AU - Barman, Nitin
AU - Moreno, Pedro
AU - Vijay, Pooja
AU - Shah, Srushthi
AU - Dangas, George
AU - Kini, Annapoorna
AU - Sharma, Samin
AU - Mehran, Roxana
N1 - Funding Information:
All consecutive patients aged ≤75 years who underwent PCI with balloon angioplasty and/or stent implantation from January 2011 to May 2016 at our center with information available on statin prescriptions at discharge were included in the present study. Patients aged >75 years are the subject of differing and specific recommendations by the 2013 AHA/ACC guidelines and thus were not included in the present analysis. Baseline and procedural characteristics as well as information concerning the lipid-lowering drug(s) prescribed at hospital discharge were obtained through a review of medical records contained in the local PCI registry. Trained research coordinators obtained 1-year outcomes data through clinical visits or telephone follow-up . End points of interest were the composite of all-cause mortality, MI according to the third universal definition, 7 or target-vessel revascularization (TVR), as well as each component within 1 year of the index procedure. Statin intensity was defined according to the definitions used in the AHA/ACC guidelines. 1 High-intensity statins included atorvastatin 40-80 mg, rosuvastatin 20-40 mg, and simvastatin 80 mg. Moderate-intensity statins were defined as atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg; lovastatin 40 mg, fluvastatin 40 mg bid, fluvastatin XL 80 mg, and pitavastatin 2-4 mg. Finally, low-intensity statin was defined as simvastatin 10 mg, pravastatin 10-20 mg, lovastatin 20 mg, fluvastatin 20-40 mg, and pitavastatin 1 mg. The present study was supported by a research grant by Regeneron Pharmaceutical ; however, the authors independently performed and are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/1
Y1 - 2019/1
N2 - Background: High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. Methods: All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. Results: A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P <.001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non–ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P <.001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P <.001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P <.001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P <.001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P =.006), Asian races (OR 0.73, 95% CI 0.65-0.83, P <.001), and older age (OR 0.90, 95% CI 0.88-0.92, P <.001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P =.84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P =.05). Conclusion: Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
AB - Background: High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. Methods: All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. Results: A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P <.001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non–ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P <.001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P <.001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P <.001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P <.001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P =.006), Asian races (OR 0.73, 95% CI 0.65-0.83, P <.001), and older age (OR 0.90, 95% CI 0.88-0.92, P <.001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P =.84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P =.05). Conclusion: Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
UR - http://www.scopus.com/inward/record.url?scp=85055817426&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2018.09.001
DO - 10.1016/j.ahj.2018.09.001
M3 - Article
C2 - 30404046
AN - SCOPUS:85055817426
SN - 0002-8703
VL - 207
SP - 10
EP - 18
JO - American Heart Journal
JF - American Heart Journal
ER -