Preprocedural statin use in patients undergoing percutaneous coronary intervention

Mohamad Kenaan, Milan Seth, Herbert D. Aronow, Joseph Naoum, Douglas Wunderly, James Mitchiner, Mauro Moscucci, Hitinder S. Gurm

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. Methods We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. Results Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P =.98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P =.11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P =.96). Conclusions A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.

Original languageEnglish
JournalAmerican Heart Journal
Volume168
Issue number1
DOIs
StatePublished - Jan 1 2014

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Percutaneous Coronary Intervention
Blue Cross Blue Shield Insurance Plans
Medicare
Odds Ratio
Myocardial Infarction
Mortality
Hospital Mortality
Coronary Artery Bypass
Registries
Cardiovascular Diseases
Stroke
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kenaan, M., Seth, M., Aronow, H. D., Naoum, J., Wunderly, D., Mitchiner, J., ... Gurm, H. S. (2014). Preprocedural statin use in patients undergoing percutaneous coronary intervention. American Heart Journal, 168(1). https://doi.org/10.1016/j.ahj.2014.03.016

Preprocedural statin use in patients undergoing percutaneous coronary intervention. / Kenaan, Mohamad; Seth, Milan; Aronow, Herbert D.; Naoum, Joseph; Wunderly, Douglas; Mitchiner, James; Moscucci, Mauro; Gurm, Hitinder S.

In: American Heart Journal, Vol. 168, No. 1, 01.01.2014.

Research output: Contribution to journalArticle

Kenaan, M, Seth, M, Aronow, HD, Naoum, J, Wunderly, D, Mitchiner, J, Moscucci, M & Gurm, HS 2014, 'Preprocedural statin use in patients undergoing percutaneous coronary intervention', American Heart Journal, vol. 168, no. 1. https://doi.org/10.1016/j.ahj.2014.03.016
Kenaan, Mohamad ; Seth, Milan ; Aronow, Herbert D. ; Naoum, Joseph ; Wunderly, Douglas ; Mitchiner, James ; Moscucci, Mauro ; Gurm, Hitinder S. / Preprocedural statin use in patients undergoing percutaneous coronary intervention. In: American Heart Journal. 2014 ; Vol. 168, No. 1.
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abstract = "Background Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. Methods We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. Results Our study population was comprised of 80,493 patients of whom 26,547 (33 {\%}) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43{\%} vs 0.42{\%}, odds ratio 1.00, 95{\%} CI 0.70-1.42, P =.98) and periprocedural myocardial infarction (2.34{\%} vs 2.10{\%}, odds ratio 1.13, 95{\%} CI 0.97-1.32, P =.11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P =.96). Conclusions A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.",
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N2 - Background Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. Methods We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. Results Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P =.98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P =.11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P =.96). Conclusions A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.

AB - Background Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. Methods We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. Results Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P =.98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P =.11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P =.96). Conclusions A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.

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