Moderate to high intensity statin in dialysis patients after acute myocardial infarction: A national cohort study in Asia

• Published in: Atherosclerosis 2017-12, Vol.267, p.158-166
• Main Authors: Chung, Chang-Min, Lin, Ming-Shyan, Chang, Chih-Hsiang, Cheng, Hui-Wen, Chang, Shih-Tai, Wang, Po-Chang, Chang, Hung-Yu, Lin, Yu-Sheng
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Aged; Cardiovascular Diseases - complications; Cardiovascular Diseases - drug therapy; Case-Control Studies; Comorbidity; Dialysis; End stage renal disease; Female; Follow-Up Studies; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Propensity Score; Proportional Hazards Models; Renal Dialysis; Retrospective Studies; Shock, Cardiogenic; Statin; Taiwan; Time Factors; Treatment Outcome
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2017.09.018

Statin is not beneficial for dialysis patients but moderate to high intensity statin is beneficial for patients after acute myocardial infarction (MI). The aim of this study was to evaluate the effect of moderate to high intensity statin on mortality, cardiovascular outcomes in dialysis patients after acute MI. Data on dialysis patients were retrieved from the National Health Insurance Research Database in Taiwan. Dialysis patients admitted for MI were selected and divided into two groups according to statin prescription or not after MI. All-cause mortality and cardiovascular outcomes after a 4-year follow-up were analyzed after propensity score matching (PSM). We identified 790 patients who received moderate to high intensity statin therapy and 1788 patients who did not receive any statins after acute MI and clinical outcomes were analyzed after 1:1 PSM. The benefit of statin on mortality therapy appeared from 1 year to the end of the 4-year follow-up period after hospitalization (statin group versus non-statin group: 22.9% vs. 31.1% at 1 year (HR: 0.70; 95% CI: 0.58–0.85); 48.0% vs. 55.1% at the end of the 4 years (HR: 0.76; 95% CI: 0.67–0.88)). In addition, the impact of statin therapy was stronger in patients with shock at admission (p = 0.035). There were no differences in any individual cardiovascular outcome or adverse event. Moderate to high intensity statin therapy might lower all-cause mortality in dialysis patients after acute MI, especially those with shock, but not influence cardiovascular outcomes and any adverse events. [Display omitted] •Moderate to high intensity statin might be beneficial in all-cause mortality in dialysis patient after acute MI.•Statin did not impact on individual cardiovascular outcome or adverse events.•Moderate to high intensity statin, in particular, should be prescribed in dialysis patients with cardiogenic shock.