Statin Eligibility and Outpatient Care Prior to ST‐Segment Elevation Myocardial Infarction. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Miedema, Michael D.; Garberich, Ross F.; Schnaidt, Lucas J.; Peterson, Erin; Strauss, Craig; Sharkey, Scott; Knickelbine, Thomas; Newell, Marc C.; Henry, Timothy D.
• Is Part Of: Journal of the American Heart Association. Volume 6:Issue 4(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-04
• Subjects: cholesterol -- prevention -- statin -- ST‐segment elevation myocardial infarction; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.116.005333
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. Methods and Results: We analyzed a prospective cohort of consecutive ST‐segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low‐density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre‐STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low‐density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138] mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. Conclusions: In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre‐STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.