Skip to main content
SpringerLink
Log in

Impact of high-dose statin on cardiovascular outcomes in real-world patients with ST-elevation acute myocardial infarction

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Little is known about the impact of a high-dose statin on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world Japanese patients. Between July 2011 and June 2017, 1110 consecutive STEMI patients underwent primary percutaneous coronary intervention at our hospital and were discharged. A high-dose statin was administered in 117 patients (10.5%) and non-high-dose statin was administered in 947 patients (85.3%). The low-density lipoprotein cholesterol level was significantly higher in the high-dose statin group at admission (129.8 ± 44.9 vs. 110.4 ± 32.7, p < 0.0001), but the levels were not significantly different at follow-up (86.7 ± 25.7 vs. 85.0 ± 25.0, p = 0.52). The cumulative 2-year incidence of a composite of cardiac death, myocardial infarction, ischemic stroke, and any unplanned coronary revascularization was significantly lower in the high-dose statin group (6.2% vs. 16.9%, log-rank p = 0.004). Propensity score matched analysis indicated similar results. Among the types of coronary revascularization, a high-dose statin was significantly correlated with a lower rate of de novo lesion revascularization (hazard ratio 0.31; 95% confidence interval 0.08–0.83; p = 0.02). The results of our analyses indicate that administration of a high-dose statin may result in better cardiovascular outcomes after STEMI mainly by reducing the rate of revascularization for de novo lesions regardless of the achieved low-density lipoprotein cholesterol level in real-world patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Daida H, Miyauchi K, Ogawa H, Yokoi H, Matsumoto M, Kitakaze M, Kimura T, Matsubara T, Ikari Y, Kimura K, Tsukahara K, Origasa H, Morino Y, Tsutsui H, Kobayashi M, Isshiki T (2013) Management and two-year long-term clinical outcome of acute coronary syndrome in Japan: prevention of atherothrombotic incidents following ischemic coronary attack (PACIFIC) registry. Circ J 77:934–943

    Article  CAS  Google Scholar 

  2. Ishihara M, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Fujino M, Yasuda S, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Hirata K, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Tobaru T, Oshima S, Nakai M, Nishimura K, Miyamoto Y, Ogawa H (2017) Long-term outcomes of non-ST-elevation myocardial infarction without creatine kinase elevation—the J-MINUET study. Circ J 81:958–965

    Article  Google Scholar 

  3. Suzuki M, Nishihira K, Takegami M, Honda S, Kojima S, Takayama M, Sumiyoshi T, Ogawa H, Kimura K, Yasuda S (2020) Clinical profiles and outcomes in the treatment of acute myocardial infarction in Japan of aging society. Heart Vessels. https://doi.org/10.1007/s00380-020-01654-5

    Article  PubMed  Google Scholar 

  4. LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK (2005) Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 352:1425–1435

    Article  CAS  Google Scholar 

  5. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM (2004) Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350:1495–1504

    Article  CAS  Google Scholar 

  6. Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA, Crowe T, Howard G, Cooper CJ, Brodie B, Grines CL, DeMaria AN (2004) Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 291:1071–1080

    Article  CAS  Google Scholar 

  7. Taguchi I, Iimuro S, Iwata H, Takashima H, Abe M, Amiya E, Ogawa T, Ozaki Y, Sakuma I, Nakagawa Y, Hibi K, Hiro T, Fukumoto Y, Hokimoto S, Miyauchi K, Yamazaki T, Ito H, Otsuji Y, Kimura K, Takahashi J, Hirayama A, Yokoi H, Kitagawa K, Urabe T, Okada Y, Terayama Y, Toyoda K, Nagao T, Matsumoto M, Ohashi Y, Kaneko T, Fujita R, Ohtsu H, Ogawa H, Daida H, Shimokawa H, Saito Y, Kimura T, Inoue T, Matsuzaki M, Nagai R (2018) High-dose versus low-dose pitavastatin in Japanese patients with stable coronary artery disease (REAL-CAD): a randomized superiority trial. Circulation 137:1997–2009

    Article  CAS  Google Scholar 

  8. Alpert JS, Thygesen K, Antman E, Bassand JP (2000) Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36:959–969

    Article  CAS  Google Scholar 

  9. JCS Joint Working Group (2013) Guidelines for secondary prevention of myocardial infarction (JCS 2011). Circ J 77:231–248

    Article  Google Scholar 

  10. Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, Egusa G, Hiro T, Hirobe K, Iida M, Kihara S, Kinoshita M, Maruyama C, Ohta T, Okamura T, Yamashita S, Yokode M, Yokote K (2013) Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan -2012 version. J Atheroscler Thromb 20:517–523

    Article  Google Scholar 

  11. Saku K, Zhang B, Noda K (2011) Randomized head-to-head comparison of pitavastatin, atorvastatin, and rosuvastatin for safety and efficacy (quantity and quality of LDL): the PATROL trial. Circ J 75:1493–1505

    Article  CAS  Google Scholar 

  12. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  Google Scholar 

  13. Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K, Sakamoto T, Tsujita K, Hagiwara N, Miyazaki S, Ako J, Arai H, Ishii H, Origuchi H, Shimizu W, Takemura H, Tahara Y, Morino Y, Iino K, Itoh T, Iwanaga Y, Uchida K, Endo H, Kongoji K, Sakamoto K, Shiomi H, Shimohama T, Suzuki A, Takahashi J, Takeuchi I, Tanaka A, Tamura T, Nakashima T, Noguchi T, Fukamachi D, Mizuno T, Yamaguchi J, Yodogawa K, Kosuge M, Kohsaka S, Yoshino H, Yasuda S, Shimokawa H, Hirayama A, Akasaka T, Haze K, Ogawa H, Tsutsui H, Yamazaki T (2019) JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome. Circ J 83:1085–1196

    Article  CAS  Google Scholar 

  14. Rosenson RS, Farkouh ME, Mefford M, Bittner V, Brown TM, Taylor B, Monda KL, Zhao H, Dai Y, Muntner P (2017) Trends in use of high-intensity statin therapy after myocardial infarction, 2011 to 2014. J Am Coll Cardiol 69:2696–2706

    Article  Google Scholar 

  15. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, Mehran R, McPherson J, Farhat N, Marso SP, Parise H, Templin B, White R, Zhang Z, Serruys PW (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364:226–235

    Article  CAS  Google Scholar 

  16. Ohmura H, Fukushima Y, Mizuno A, Niwa K, Kobayashi Y, Ebina T, Kimura K, Ishibashi S, Daida H (2017) Estimated prevalence of heterozygous familial hypercholesterolemia in patients with acute coronary syndrome. Int Heart J 58:88–94

    Article  Google Scholar 

  17. Harada-Shiba M, Ako J, Arai H, Hirayama A, Murakami Y, Nohara A, Ozaki A, Uno K, Nakamura M (2018) Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome in Japan: results of the EXPLORE-J study. Atherosclerosis 277:362–368

    Article  CAS  Google Scholar 

  18. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H, Lewis BS, Ophuis TO, Jukema JW, De Ferrari GM, Ruzyllo W, De Lucca P, Im K, Bohula EA, Reist C, Wiviott SD, Tershakovec AM, Musliner TA, Braunwald E, Califf RM (2015) Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 372:2387–2397

    Article  CAS  Google Scholar 

  19. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, Edelberg JM, Goodman SG, Hanotin C, Harrington RA, Jukema JW, Lecorps G, Mahaffey KW, Moryusef A, Pordy R, Quintero K, Roe MT, Sasiela WJ, Tamby JF, Tricoci P, White HD, Zeiher AM (2018) Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 379:2097–2107

    Article  CAS  Google Scholar 

  20. Nakahashi T, Tada H, Sakata K, Yakuta Y, Tanaka Y, Nomura A, Gamou T, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Hayashi K, Yamagishi M, Kawashiri MA (2018) Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome. Heart Vessels 33:695–705

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Makiko Kanaike, Yoshimi Akashi, and Takako Yukiyoshi for their secretarial assistance with the manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan

    Takenobu Shimada, Kohei Osakada, Koya Okabe, Yuki Shima, Seiji Habara, Takeshi Tada, Yuya Taguchi, Akihiro Ikuta, Makoto Takamatsu, Ryosuke Murai, Katsuya Miura, Masanobu Ohya, Hidewo Amano, Shunsuke Kubo, Hiroyuki Tanaka, Takeshi Maruo, Yasushi Fuku, Harumi Katoh, Tsuyoshi Goto & Kazushige Kadota

  2. Eguchi Internal Medicine Clinic, 6-43 Enyaariharachou, Izumo, Shimane, 693-0023, Japan

    Haruki Eguchi

Authors
  1. Takenobu Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kohei Osakada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koya Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuki Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haruki Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seiji Habara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeshi Tada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuya Taguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akihiro Ikuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Makoto Takamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryosuke Murai
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Katsuya Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masanobu Ohya
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hidewo Amano
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shunsuke Kubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hiroyuki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Takeshi Maruo
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Yasushi Fuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Harumi Katoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Tsuyoshi Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Kazushige Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takenobu Shimada.

Ethics declarations

Conflict of interest

All authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shimada, T., Osakada, K., Okabe, K. et al. Impact of high-dose statin on cardiovascular outcomes in real-world patients with ST-elevation acute myocardial infarction. Heart Vessels 36, 297–307 (2021). https://doi.org/10.1007/s00380-020-01696-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01696-9

Keywords

Search

Navigation