Statin therapy to reduce stent thrombosis in acute myocardial infarction patients with elevated high-sensitivity C-reactive protein

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Abstract

Objective

We investigated whether statin therapy and high-sensitivity C-reactive protein (hs-CRP) levels were associated with the risk of stent thrombosis (ST) in acute myocardial infarction (AMI) patients.

Methods

A total of 9,162 AMI patients who underwent coronary stent implantation were analyzed in the Korean Acute Myocardial Infarction Registry. The study population was divided into four groups according to level of hs-CRP and peri-procedural statin treatment: low hs-CRP (≤ 2.0 mg/L) and high hs-CRP (> 2 mg/L) with or without statin therapy. We compared the incidence of early ST among the groups.

Results

Statin therapy did not significantly affect the development of early ST in the low hs-CRP group. In the high hs-CRP group, however, the incidence of early ST was significantly decreased with statin treatment. In a subgroup analysis of the high hs-CRP group, patients aged less than 65 years, without diabetes, with a high body mass index, and with a high Killip class seemed to benefit more from statin therapy. In a multivariable Cox regression analysis of the high hs-CRP group, lack of statin therapy was a significant predictor of ST incidence.

Conclusions

Peri-procedural statin treatment had an effect on reduced incidence of early ST in AMI patients with high levels of hs-CRP.

Introduction

Stent thrombosis (ST) is a rare complication following coronary stenting, but is associated with serious consequences, in particular, death and acute myocardial infarction (AMI) [1]. The cumulative evidence suggests that the degree of inflammation correlates with prognosis after percutaneous coronary intervention (PCI), such as ST, and additionally, that there is a cross-link between platelet activation and inflammatory pathways [2]. Therefore, patients prone to low-grade inflammation are at greater risk for adverse outcomes after stenting. Among the available inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) is one of the most accessible for clinical practice. Several studies have shown that hs-CRP elevation is associated with cardiovascular events in the healthy general population [3] as well as in patients with coronary artery disease [4]. Furthermore, pre-procedural hs-CRP levels are predictive of ischemic complications after PCI [5]. And, recent studies have demonstrated the beneficial effects of statins (3-hydroxy-3-methylglutaryl-CoA reductase inhibitors) in patients with cardiovascular disease [6]. The non-lipid-lowering, pleiotropic effects of statins include improvement in endothelial function and reductions in oxidative stress, inflammation, and platelet activation [7]. However, clinical data linking hs-CRP or statins with the risk of ST are limited. We therefore investigated whether peri-procedural statin therapy and hs-CRP levels were associated with the risk of ST in AMI patients treated by PCI with stent implantation.

Section snippets

Korea Acute Myocardial Infarction Registry (KAMIR)

The Korea Acute Myocardial Infarction Registry (KAMIR) is a Korean prospective, multi-center, and observational online registry that is designed to reflect the “real-world” practice in Korean AMI patients with support from the Korean Circulation Society from November 2005. Online registry of AMI (at www.kamir.or.kr) has been performed at 52 university or community hospitals that are high-volume centers with facilities for primary PCI and onsite cardiac surgery. The study protocol was approved

Baseline clinical characteristics

As shown Table 1, the patient's baseline clinical characteristics were similar among the groups. However, BMI was higher in the low and high hs-CRP with statin groups than in the without statin groups. Also, more patients in the low and high hs-CRP without statin groups had a higher Killip class. The low and high hs-CRP with statin groups had more patients with hyperlipidemia: moreover, the levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were higher in these same

Discussion

In the current study, we investigated the effects of statins on ST in the KAMIR patients. The major finding of our study was that statin therapy significantly reduced the incidence of early ST in AMI patients with elevated levels of hs-CRP. These effects were consistent in several of the subgroups evaluated, including subgroups customarily considered to be at low risk, such as young and non-diabetic patients.

Conclusions

The present study showed that peri-procedural statin treatment had an effect on reduced incidences of early ST in AMI patients with high levels of hs-CRP who underwent PCI with stent implantation. Notably, patients aged less than 65 years, without diabetes, with BMI  25.0 kg/m, and with a high Killip class seemed to benefit more from the statin therapy. Therefore, these results might provide the rationale for the use of peri-procedural statin therapy in these patients.

Acknowledgments

This work was supported by a grant of the National Research Foundation of Korea funded by the Korean Government (MEST), Republic of Korea (2010-0020261), and by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A084869).

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.

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