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Early statin treatment following acute myocardial infarction and 1-year survival
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
Department of Cardiology, University Hospital of Uppsala, Uppsala, Sweden.
2001 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 285, no 4, 430-436 p.Article in journal (Refereed) Published
Abstract [en]

CONTEXT:

Randomized trials have established statin treatment as secondary prevention in coronary artery disease, but it is unclear whether early treatment with statins following acute myocardial infarction (AMI) influences survival.

OBJECTIVE:

To evaluate the association between statin treatment initiated before or at the time of hospital discharge and 1-year mortality after AMI.

DESIGN AND SETTING:

Prospective cohort study using data from the Swedish Register of Cardiac Intensive Care on patients admitted to the coronary care units of 58 Swedish hospitals in 1995-1998. One-year mortality data were obtained from the Swedish National Cause of Death Register.

PATIENTS:

Patients with first registry-recorded AMI who were younger than 80 years and who were discharged alive from the hospital, including 5528 who received statins at or before discharge and 14 071 who did not.

MAIN OUTCOME MEASURE:

Relative risk of 1-year mortality according to statin treatment.

RESULTS:

At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P =.001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications.

CONCLUSIONS:

Early initiation of statin treatment in patients with AMI is associated with reduced 1-year mortality. These results emphasize the importance of implementing the results of randomized statin trials in unselected AMI patients.

Place, publisher, year, edition, pages
2001. Vol. 285, no 4, 430-436 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27148PubMedID: 11242427Local ID: 11796OAI: oai:DiVA.org:liu-27148DiVA: diva2:247699
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Improving outcome in acute myocardial infarction
Open this publication in new window or tab >>Improving outcome in acute myocardial infarction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Despite common guidelines there are vanatlons in the treatment of acute myocardial infarction (AMI) between hospitals in Sweden. Uncertainties remain regarding the efficacy of early statin therapy and early revascularisation in AMI patients. In the elderly patients also the role of fibrinolytic therapy has been questioned.

Methods: We created a national quality assurance register named RIKS-HIA including all patients admitted to participating hospitals' ICCU. The database accumulates information about baseline characteristics, interventions, complications and outcome in consecutive patients. The merging of the database with the Cause of Death Register provides  opportunity to compare the effects of treatments on long-term outcome. Multivariate Cox regression analysis and propensity score was used to evaluate outcome in AMI patients of the studied interventions, and to compare activity level between different hospitals.

Results: After patient characteristics were taken into account there were still significant differences between the hospitals in some treatment modalities that remained over time. There was no correlation between hospital size and activity level. In 19 599 in-hospital survivors after their first registry-recorded AMI at an age below 80 years early statin treatment was associated with a 25 % relative risk reduction of I-year mortality. In 21 912 patients with first registry-recorded AMI younger than 80 years and alive at day 14, early revascularisation was associated with a 50 % relative reduction of I-year mortality. For both therapies the effects were homogeneous among all subgroups based on age, gender, baseline characteristics, previous disease manifestations and medication. Fibrinolytic therapy in ST-segment elevation myocardial infarction patients 75 years of age and older showed a net benefit of 13% in outcome when non-fatal intracranial haemorrhage and I-year survival were analysed.

Conclusion: The results indicates the need of continuous quality assurance, and strategies to reduce the differences in AMI therapy between hospitals. They lend support to early statin and early revascularisation regimens in AMI patients. Fibrinolytic therapy is recommended also in the elderly patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 740
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27543 (URN)12202 (Local ID)91-7373-189-7 (ISBN)12202 (Archive number)12202 (OAI)
Public defence
2002-11-07, Elsa Brändströmsalen, Campus US, Linköpings universtiet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-19Bibliographically approved

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