Statin therapy among chronic kidney disease patients presenting with acute coronary syndrome. (July 2019)

• Record Type: Journal Article
• Authors: Natanzon, Sharon Shalom; Matetzky, Shlomi; Beigel, Roy; Iakobishvili, Zaza; Goldenberg, Ilan; Shechter, Michael
• Is Part Of: Atherosclerosis. Volume 286(2019)
• Page Start: 14
• Page End: 19
• Publication Date: 2019-07
• Subjects: Chronic kidney disease -- Acute coronary syndrome -- Statins -- Prognosis; ACS acute coronary syndrome -- ACSIS acute coronary syndrome Israeli survey -- CKD chronic kidney disease -- CVA cerebrovascular accident -- eGFR estimated glomerular filtration rate -- ICCU intensive coronary care unit -- MACE major adverse cardiovascular events -- NSTEMI non ST-elevation myocardial infarction; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2019.05.002
• Languages: English
• ISSNs: 0021-9150

Abstract

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 m 2 (n = 525, 6%), eGFR 30–59 ml/min/1.73 m 2 (n = 1919, 21%), and eGFR>60 ml/min/1.73 m 2 (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 m 2 -95%, eGFR 30–59 ml/min/1.73 m 2 -90%, eGFR<30 ml/min/1.73 m 2 -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. Graphical abstract: Image 1 Highlights: Despite current guidelines, statins are still underused among chronic kidney disease patients. Chronic kidney disease patients presenting with acute coronary syndrome have both short- and long-term adverse outcomes. Statins beneficial effect is maintained among chronic kidney disease patients presenting with acute coronary syndrome regardless of renal function.