Statin therapy and clinical outcomes in myocardial infarction patients complicated by acute heart failure: insights from the EPHESUS trial

• Published in: European journal of heart failure 2013-02, Vol.15 (2), p.221-227
• Main Authors: Dobre, Daniela, Rossignol, Patrick, Murin, Jan, Parkhomenko, Alexander, Lamiral, Zohra, Krum, Henry, van Veldhuisen, Dirk J., Pitt, Bertram, Zannad, Faiez
• Format: Article
• Language: English
• Subjects: Acute Disease; acute heart failure; acute myocardial infarction; Aged; Double-Blind Method; Drug Therapy, Combination; EPHESUS trial; Female; Heart Failure, Systolic - drug therapy; Heart Failure, Systolic - mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - adverse effects; Mineralocorticoid Receptor Antagonists - therapeutic use; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Propensity Score; Spironolactone - adverse effects; Spironolactone - analogs & derivatives; Spironolactone - therapeutic use; statin therapy; Stroke Volume - drug effects; Survival Analysis; Treatment Outcome; United States
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfs128

Aims Several clinical trials have shown that in patients with acute myocardial infarction (MI), statin therapy improves cardiovascular (CV) outcomes, but in these trials patients with acute heart failure (HF) were excluded or only a few were included. In patients with chronic HF, statin therapy does not reduce all‐cause or CV mortality. We aimed to assess the association between statin therapy and clinical outcomes in the setting of acute HF with systolic dysfunction complicating acute MI. Methods and results We performed a post‐hoc analysis in 6632 patients included in the EPHESUS trial. The mean age of patients was 64 years and 71% were male. Overall, 47% of patients had a statin prescribed at baseline. Cox regression models and a secondary analysis using propensity score matching were fit to assess the association between statin prescription and clinical outcomes. During a mean follow‐up of 16 ± 7 months, all‐cause death occurred in 385 (12%) patients with and in 647 (18%) patients without a statin (P < 0.001). After extensive adjustment, the risk of all‐cause death was 20% lower in patients on statin [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.69–0.92, P = 0.001]. This positive association was mostly due to a lower risk of CV death (HR 0.76, 95% CI 0.65–0.88, P = 0.0002). In contrast, statin use was associated with a higher risk of non‐CV hospitalizations (HR 1.16, 95% CI 1.02–1.33, P = 0.02). Conclusion Our results suggest that patients with acute HF complicating acute MI may benefit from being on statin therapy. Prospective clinical trials are required to validate these findings.