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Statin therapy among chronic kidney disease patients presenting with acute coronary syndrome.

Abstract：

BACKGROUND AND AIMS:The beneficial effect of statin therapy has been well established for both primary and secondary prevention of cardiovascular disease. Nevertheless, it remains under-used among patients with chronic kidney disease (CKD). We aimed to investigate the impact of statin therapy across a wide spectrum of CKD patients presenting with acute coronary syndrome (ACS). METHODS:We included all patients with ACS enrolled in the Acute Coronary Syndrome Israel Survey (ACSIS) between the years 2006 and 2016, and allocated them to 3 groups according to their renal function based on an estimated glomerular filtration rate (eGFR) calculation on admission (MDRD formula): eGFR<30 ml/min/1.73 m2 (n = 525, 6%), eGFR 30-59 ml/min/1.73 m2 (n = 1919, 21%), and eGFR>60 ml/min/1.73 m2 (n = 6501, 73%). Primary outcome included in-hospital, 30-day, and 1-year major adverse cardiovascular events (MACE), and the independent prognostic effect of statins among CKD patients with ACS, by Cox regression analysis. RESULTS:All 8945 consecutive ACS patients were included in our analysis. On hospital discharge, statin prescriptions were negatively associated with eGFR ]eGFR>60 ml/min/1.73 m2 -95%, eGFR 30-59 ml/min/1.73 m2 -90%, eGFR<30 ml/min/1.73 m2 -78% (p < 0.001 for trend). Kaplan-Meier curves demonstrated both short and long-term higher mortality rates in those prescribed compared with those not prescribed statins (p < 0.001), regardless of renal function. Cox regression analysis revealed the protective effect of discharge statins (HR-0.25, 95% C.I 0.2-0.3, p < 0.001). CONCLUSIONS:In our study, the beneficial effect of statins was maintained among CKD patients presenting with ACS. Therefore, these patients should be treated with statins regardless of their eGFR.

journal_name

Atherosclerosis

journal_title

Atherosclerosis

authors

Natanzon SS,Matetzky S,Beigel R,Iakobishvili Z,Goldenberg I,Shechter M,Acute Coronary Syndrome Israel Survey (ACSIS) investigators.

doi

10.1016/j.atherosclerosis.2019.05.002

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

14-19

eissn

0021-9150

issn

1879-1484

pii

S0021-9150(19)30407-1

journal_volume

286

pub_type

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Statin therapy among chronic kidney disease patients presenting with acute coronary syndrome.