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Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to percutaneous coronary interventions (PCIs). But is that recommendation followed? And does it improve patient outcomes?
Researchers for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium in Ann Arbor, Mt. Clemens, Kalamazoo, and Farmington Hills, all in Michigan; and Miami, Florida, evaluated the incidence and in-hospital outcomes associated with statin pretreatment among 80,493 patients. Their key finding, they say, was that many patients—26,547 (33%)—did not receive guideline-recommended statins before PCI, even if they were hemodynamically stable and had no documented contraindication. The researchers found the relatively high incidence of nonuse even more surprising, given that all the hospitals included in the study participated in an active multicenter quality improvement collaborative.
However, that nonuse did not appear to make much of a difference. Patients who did not receive statins had a similar rate of in-hospital mortality (43% in nonusers of statin vs 42% in statin users) and periprocedural myocardial infarction (MI) (2.34% in nonusers of statin vs 2.10% in statin users). Most notably, there was no reduction in postprocedural MI, a finding that some smaller studies suggested was related to statins’ effects.
Similarly, the researchers found no statin-related difference in the rate of coronary artery bypass grafting, cerebrovascular accident, or contrast-induced nephropathy. Finally, they found no statistically significant benefit from statins on mortality after a 36-month follow-up.
The researchers conclude that more studies need to be completed to support the role for statin administration prior to PCI as currently recommended in the guidelines.
Source
Kenaan M, Seth M, Aronow HD, et al. Am Heart J. 2014;168(1):110-116.e3.
doi: 10.1016/j.ahj.2014.03.016.
Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to percutaneous coronary interventions (PCIs). But is that recommendation followed? And does it improve patient outcomes?
Researchers for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium in Ann Arbor, Mt. Clemens, Kalamazoo, and Farmington Hills, all in Michigan; and Miami, Florida, evaluated the incidence and in-hospital outcomes associated with statin pretreatment among 80,493 patients. Their key finding, they say, was that many patients—26,547 (33%)—did not receive guideline-recommended statins before PCI, even if they were hemodynamically stable and had no documented contraindication. The researchers found the relatively high incidence of nonuse even more surprising, given that all the hospitals included in the study participated in an active multicenter quality improvement collaborative.
However, that nonuse did not appear to make much of a difference. Patients who did not receive statins had a similar rate of in-hospital mortality (43% in nonusers of statin vs 42% in statin users) and periprocedural myocardial infarction (MI) (2.34% in nonusers of statin vs 2.10% in statin users). Most notably, there was no reduction in postprocedural MI, a finding that some smaller studies suggested was related to statins’ effects.
Similarly, the researchers found no statin-related difference in the rate of coronary artery bypass grafting, cerebrovascular accident, or contrast-induced nephropathy. Finally, they found no statistically significant benefit from statins on mortality after a 36-month follow-up.
The researchers conclude that more studies need to be completed to support the role for statin administration prior to PCI as currently recommended in the guidelines.
Source
Kenaan M, Seth M, Aronow HD, et al. Am Heart J. 2014;168(1):110-116.e3.
doi: 10.1016/j.ahj.2014.03.016.
Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to percutaneous coronary interventions (PCIs). But is that recommendation followed? And does it improve patient outcomes?
Researchers for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium in Ann Arbor, Mt. Clemens, Kalamazoo, and Farmington Hills, all in Michigan; and Miami, Florida, evaluated the incidence and in-hospital outcomes associated with statin pretreatment among 80,493 patients. Their key finding, they say, was that many patients—26,547 (33%)—did not receive guideline-recommended statins before PCI, even if they were hemodynamically stable and had no documented contraindication. The researchers found the relatively high incidence of nonuse even more surprising, given that all the hospitals included in the study participated in an active multicenter quality improvement collaborative.
However, that nonuse did not appear to make much of a difference. Patients who did not receive statins had a similar rate of in-hospital mortality (43% in nonusers of statin vs 42% in statin users) and periprocedural myocardial infarction (MI) (2.34% in nonusers of statin vs 2.10% in statin users). Most notably, there was no reduction in postprocedural MI, a finding that some smaller studies suggested was related to statins’ effects.
Similarly, the researchers found no statin-related difference in the rate of coronary artery bypass grafting, cerebrovascular accident, or contrast-induced nephropathy. Finally, they found no statistically significant benefit from statins on mortality after a 36-month follow-up.
The researchers conclude that more studies need to be completed to support the role for statin administration prior to PCI as currently recommended in the guidelines.
Source
Kenaan M, Seth M, Aronow HD, et al. Am Heart J. 2014;168(1):110-116.e3.
doi: 10.1016/j.ahj.2014.03.016.