Long-term Survival Benefit of Statin in Patients with Coronary Chronic Total Occlusion without Revascularization.

Abstract

BACKGROUND:

Limited data are available on the efficacy of statin therapy in stable ischemic heart disease with chronic total occlusion (CTO) without revascularization. We investigated whether statin therapy could be beneficial in stable patients with CTO without revascularization.

METHODS:

From March 2003 to February 2012, 2,024 patients with at least one CTO were enrolled in a retrospective, single-center registry; 664 of these patients were managed conservatively without an initial revascularization strategy. Among them, we excluded CTO cases involving acute coronary syndrome, in-hospital death or incomplete data and classified 551 patients into statin (n = 369) and non-statin (n = 182) groups according to use of statin at discharge. Propensity score matching analysis was also performed in 148 pairs. The primary outcome was cardiac death.

RESULTS:

The median overall follow-up duration was 45.7 months (interquartile range: 19.9-70.5 months). Cardiac death occurred in 22 patients (6.0%) in the statin group vs. 24 patients (13.2%) in the non-statin group (P < 0.001). In propensity score matching analysis, statin therapy was associated with a low risk of cardiac death (adjusted hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.18-0.85; P = 0.022) and major adverse cardiac events (adjusted HR, 0.66; 95% CI, 0.43-0.98; P = 0.043). On multivariate analysis, independent predictors for cardiac death were age > 70 years, renal insufficiency, prior myocardial infarction, left ventricular ejection fraction < 40%, proximal-to-mid CTO location, and no use of statin in CTO patients.

CONCLUSION:

Statin therapy at discharge may be associated with a reduction in long-term cardiac mortality in stable CTO patients without revascularization.

• Authors: Bum Sung Kim, Jeong Hoon Yang, Woo Jin Jang, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Ki Hong Choi, Sung-Hea Kim, Woo Jung Chun, Hyeon-Cheol Gwon, Seung-Hyuk Choi
• Journal: Journal of Korean medical science (J Korean Med Sci) Vol. 33 Issue 18 Pg. e134 (Apr 30 2018) ISSN: 1598-6357 [Electronic] Korea (South)
• PMID: 29713254 (Publication Type: Journal Article)

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Chronic Disease
• Coronary Occlusion (drug therapy, mortality, pathology)
• Death
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (etiology)
• Myocardial Revascularization
• Propensity Score
• Proportional Hazards Models
• Registries
• Retrospective Studies
• Risk Factors
• Treatment Outcome