The Impact of Statin Pre-Treatment and LDL Levels on the Rate of STEMI Presentation: Data from the ACS Israeli Survey (ACSIS) 2008-2018

Background: ST-elevation myocardial infarction (STEMI) mostly occurs as a result of vulnerable coronary artery plaque rupture. Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and can thus prevent STEMI events.

Objective: To determine the association between statin pre-treatment and its intensity, low-density-lipoprotein cholesterol (LDL-C) levels and presentation of patients with an ACS (STEMI vs. NSTEMI).

Methods: Data was drawn from the ACSIS Surveys in 2008-2018. The incidence of STEMI vs NSTEMI/unstable angina at the time of presentation was calculated according to LDL-C levels on admission, stratified to 5 subgroups (<50, 50-69, 70-100, 101-130 and >130 mg/dl) and the use of statins, including statin intensity, prior to the index ACS event.

Results: Among the 5,103 patients, 875 were pre-treated with high intensity statin (HIST), 1,389 with low intensity statin (LIST), and 2,839 were statin naive. Statin-pre-treated patients were older, more likely to suffer from co-morbidities and cardiovascular diseases, and were more often pre-treated with anti-platelets drugs.

The proportion of patients presenting with STEMI vs. NSTEMI was significantly lower among HIST vs. LIST vs. statin naive patients (31.0%, 37.8%, 54.0%, respectively, p for trend <0.001). At each LDL-C level, the proportion of STEMI was significantly lower among HIST vs. LIST vs. statin naive patients. Multivariate analysis revealed that HIST was independently associated with lower STEMI presentation, but LDL-C.

Conclusions: Among patients admitted with ACS, pre-treatment with high intensity statin therapy was the only predictor independently associated with a lower probability of presenting with STEMI.