Background: STEMI is thought to occur as a result of a vulnerable coronary plaque rupture. Statins posses hypolipidemic and pleotropic effects and can stabilize coronary artery plaque.
Aim: To determine the association between LDL-C levels, with or without concurrent statin use on the presentation of patients with an ACS(STEMI vs. NSTEMI).
Methods: Data was drawn from the Acute Coronary Syndrome Israeli Surveys(ACSIS), from the years 2002-2010. The incidence of STEMI presentation was calculated according to LDL-Clevels (<50, 50-69, 70-100, 101-130 and >130 mg/dl) on admission and the use of statins prior to the index ACS.
Results: Among 6790 patients, 2760(41%) were on statins and 4030(59%) were statin naïve before the index ACS event. The proportion of STEMI at presentation was significantly lower among statin treated vs. statin naïve pts(36% vs. 57%, p<0.0001). At each LDL-C level, the proportion of STEMI was significantly lower among statin treated vs. statin naïve pts (Figure, p<0.0001, for all comparisons). LDL-C<70mg/dl was associated with a lower proportion of STEMI presentation only among statin treated pts, but not among statin naïve pts (33% vs. 57%, p<0.0001).
Multivariate analysis (adjusting for the propensity score for statin use, including pertinent baseline variables, chronic medications, statin use and LDL-C levels) revealed that statin use was independently associated with lower STEMI presentation(OR=0.73, p<0.007), but LDL-C<70mg/dl was not (OR=1.13, p=0.33). Similar results were obtained when the analyses were done separately among patients with or without prior cardiovascular disease.
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Conclusions: In patients presenting with ACS, statin use but not LDL-C level was associated with lower incidence of STEMI as compared with NSTEMI. The lower incidence of STEMI in statin treated patients as compared to NSTEMI may be explained by the pleotropic effect of statins and may explain the worldwide trend of reduced incidence of STEMI.
