Chronic statin-use before PCI in acute coronary syndromes and in-hospital outcomes: ACCNCDR registry in India

Abstract

Objective

To compare in-hospital major cardiovascular adverse outcomes among chronic statin-user and statin-naïve acute coronary syndrome(ACS) patients following percutaneous coronary intervention(PCI).

Methods

Successive patients with ACS who underwent PCI from Sep’17 to Dec’23 were enrolled in a prospective registry. Details of risk factors, presentation, angiography, interventions, and in-hospital outcomes were recorded. Chronic statin use was defined as > 1-month intake before presentation. Primary outcomes were in-hospital all-cause and cardiovascular deaths. Univariate and multivariate odds ratios(OR) and 95 % confidence intervals(CI) were calculated.

Results

8296 patients were enrolled, and ACS was in 7892(STEMI-ST elevation myocardial infarction 3222, non-STEMI/unstable angina 4670). Prior chronic statin use was in 2949(37.4 %), and 4943(62.6 %) were statin naïve. Statin-user vs. statin-naïve patients were older(62±10 vs. 60±11y), with more hypertension(61 vs. 48 %), diabetes(36 vs. 32 %), prior PCI(20 vs 8 %), CABG(5 vs 2 %), beta-blockers(61.7 vs 8.3 %), anti-platelets(92.8 vs 5.3 %), and lower mean total-, LDL-, and non-HDL-cholesterol(p < 0.001); chronic statin users had less STEMI(30 % vs 47 %) and better LVEF(46.5 ± 10 vs 44.5 ± 10 %) at presentation and median hospitalization was shorter(66.3 vs 68.6 h)(p < 0.001). In statin-user vs. statin-naïve groups, the incidence of all-cause deaths: 33(1.12 %) vs 85(1.72 %) (OR 0.65, CI 0.43–0.97) and CV deaths: in 29(0.98 %) vs 73(1.47 %) (OR 0.67, CI 0.43–1.02) were lower. The ORs attenuated following multivariate adjustments for risk factors, previous treatments, clinical features, angiographic findings and interventions.

Conclusions

Acute coronary syndrome patients taking pre-admission statins and other cardioprotective medicines have lower in-hospital all-cause deaths. This is associated with less STEMI, better LVEF, and shorter hospitalization in prior statin users.