Impact of Prior Statin Therapy on Arrhythmic Events in Patients With Acute Coronary Syndromes (from the Global Registry of Acute Coronary Events [GRACE])

• Published in: The American journal of cardiology 2009-12, Vol.104 (12), p.1613-1617
• Main Authors: Vedre, Ameeth, MD, Gurm, Hitinder S., MD, Froehlich, James B., MD, MPH, Kline-Rogers, Eva, RN, MS, Montalescot, Gilles, MD, PhD, Gore, Joel M., MD, Brieger, David, MBBS, PhD, Quill, Ann L., MA, Eagle, Kim A., MD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Aged; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - prevention & control; Cardiac arrhythmia; Cardiovascular; Drug therapy; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Impact analysis; Male; Middle Aged; Primary Prevention; Risk Factors; Statins; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.07.045

Animal models of myocardial ischemia have demonstrated reduction in arrhythmias using statins. It was hypothesized that previous statin therapy before hospitalization might be associated with reductions of in-hospital arrhythmic events in patients with acute coronary syndromes. In this multinational, prospective, observational study (the Global Registry of Acute Coronary Events [GRACE]), data from 64,679 patients hospitalized for suspected acute coronary syndromes (from 1999 to 2007) were analyzed. The primary outcome of interest was in-hospital arrhythmic events in previous statin users compared with nonusers. The 2 primary end points were atrial fibrillation and the composite end point of ventricular tachycardia, ventricular fibrillation, and/or cardiac arrest. In-hospital death was also examined. Of the 64,679 patients, 17,636 (27%) had received previous statin therapy. Those taking statins had higher crude rates of histories of angina (69% vs 46%), diabetes (34% vs 22%), heart failure (15% vs 8.4%), hypertension (74% vs 58%), atrial fibrillation (9.3% vs 7.0%), and dyslipidemia (85% vs 35%). Patients previously taking statins were less likely to have in-hospital arrhythmias. In propensity-adjusted multivariable models, previous statin use was associated with a lower risk for ventricular tachycardia, ventricular fibrillation, or cardiac arrest (odds ratio 0.81, 95% confidence interval 0.72 to 0.96, p = 0.002); atrial fibrillation (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, p