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Statin Treatment Intensity, Discontinuation, and Long-Term Outcome in Patients with Acute Myocardial Infarction and Impaired Kidney Function

Khedri, Masih ; Szummer, Karolina ; Lundman, Pia ; Jernberg, Tomas ; Desta, Liyew ; Lindahl, Bertil ; Erlinge, David LU orcid ; Jacobson, Stefan H. and Spaak, Jonas (2023) In Journal of Cardiovascular Pharmacology 81(6). p.400-410
Abstract

Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 25% discontinued treatment the... (More)

Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 25% discontinued treatment the first year; however, the discontinuation rate was similar regardless of the statin intensity. After excluding patients who died, changed therapy, or were nonadherent during the first year, 84,705 remained for the on-treatment analysis (OT-A). Patients were followed for 12.6 (median 5.6) years. In patients with eGFR 30-59 mL/min, high-intensity statin was associated with lower risk for the composite death, reinfarction, or stroke both in ITT-A (hazard ratio [HR] 0.93; 95% confidence interval, 0.87-0.99) and OT-A (HR 0.90; 0.83-0.99); the interaction test for OT-A indicated no heterogeneity for the eGFR < 60 mL/min group (P = 0.46). Similar associations were seen for all-cause mortality. We confirm that high-intensity statin treatment is associated with improved long-term outcome after AMI in patients with reduced kidney function. Most patients with reduced kidney function initiated on high-intensity statins are persistent after 1 year and equally persistent as patients initiated on low-moderate intensity.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute myocardial infarction, chronic kidney disease, mortality, reinfarction, statin intensity, stroke
in
Journal of Cardiovascular Pharmacology
volume
81
issue
6
pages
11 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:36735336
  • scopus:85161916608
ISSN
0160-2446
DOI
10.1097/FJC.0000000000001402
language
English
LU publication?
yes
id
c77a387f-c8d9-4d05-bc0d-7f79882e4144
date added to LUP
2023-09-15 11:10:33
date last changed
2024-04-20 03:24:45
@article{c77a387f-c8d9-4d05-bc0d-7f79882e4144,
  abstract     = {{<p>Statin dosage in patients with acute myocardial infarction (AMI) and concomitant kidney dysfunction is a clinical dilemma. We studied discontinuation during the first year after an AMI and long-term outcome in patients receiving high versus low-moderate intensity statin treatment, in relation to kidney function. For the intention-to-treat analysis (ITT-A), we included all patients admitted to Swedish coronary care units for a first AMI between 2005 and 2016 that survived in-hospital, had known creatinine, and initiated statin therapy (N = 112,727). High intensity was initiated in 38.7% and low-moderate in 61.3%. In patients with estimated glomerular filtration rate (eGFR) &lt; 60 mL/min/1.73 m<sup>2</sup>, 25% discontinued treatment the first year; however, the discontinuation rate was similar regardless of the statin intensity. After excluding patients who died, changed therapy, or were nonadherent during the first year, 84,705 remained for the on-treatment analysis (OT-A). Patients were followed for 12.6 (median 5.6) years. In patients with eGFR 30-59 mL/min, high-intensity statin was associated with lower risk for the composite death, reinfarction, or stroke both in ITT-A (hazard ratio [HR] 0.93; 95% confidence interval, 0.87-0.99) and OT-A (HR 0.90; 0.83-0.99); the interaction test for OT-A indicated no heterogeneity for the eGFR &lt; 60 mL/min group (P = 0.46). Similar associations were seen for all-cause mortality. We confirm that high-intensity statin treatment is associated with improved long-term outcome after AMI in patients with reduced kidney function. Most patients with reduced kidney function initiated on high-intensity statins are persistent after 1 year and equally persistent as patients initiated on low-moderate intensity.</p>}},
  author       = {{Khedri, Masih and Szummer, Karolina and Lundman, Pia and Jernberg, Tomas and Desta, Liyew and Lindahl, Bertil and Erlinge, David and Jacobson, Stefan H. and Spaak, Jonas}},
  issn         = {{0160-2446}},
  keywords     = {{acute myocardial infarction; chronic kidney disease; mortality; reinfarction; statin intensity; stroke}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{400--410}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Cardiovascular Pharmacology}},
  title        = {{Statin Treatment Intensity, Discontinuation, and Long-Term Outcome in Patients with Acute Myocardial Infarction and Impaired Kidney Function}},
  url          = {{http://dx.doi.org/10.1097/FJC.0000000000001402}},
  doi          = {{10.1097/FJC.0000000000001402}},
  volume       = {{81}},
  year         = {{2023}},
}