To date, there has been no dedicated study on AMI that directly compared low-moderate- and high-intensity statin in contemporary practice.
![high intensity statin list high intensity statin list](https://i1.rgstatic.net/publication/323552376_Temporal_Trends_of_High-Intensity_Statin_Therapy_Among_Veterans_Treated_With_Percutaneous_Coronary_Intervention/links/5a9d4b2245851586a2aec6c3/largepreview.png)
While others evaluated patients with stable coronary artery disease (CAD). Only 2 evaluated patients with ACS, 2, 3 In addition, of 5 RCT that directly compared lower intensity and higher intensity statin regimens, 2, 3, 11 – 13 6Īll previous studies included in the meta-analysis, however, were performed during the first-generation drug-eluting stent (DES) era. In a recent large-scale meta-analysis, every 1.0-mmol/L reduction of LDL-C produced further reduction in the annual rate of major cardiovascular events, consisting of coronary death, non-fatal MI, revascularization, and stroke, by just over a fifth. The major difference between these 2 guidelines is that the ACCF/AHA guideline does not refer to the specific goal of low-density lipoprotein cholesterol (LDL-C), while the ESC guideline recommends the LDL-C goal <70 mg/dL in patients with AMI. In this regard, current ACCF/AHA (American College of Cardiology Foundation/American Heart Association) and ESC (European Society of Cardiology) guidelines have stated initiation of high-intensity statins after AMI as a class I recommendation. Previous randomized controlled studies (RCT) and meta-analyses have indicated added clinical benefits of higher intensity statin therapy in patients with acute coronary syndrome (ACS) or stable angina. The use of statins after acute myocardial infarction (AMI) reduces the risks of death, recurrent myocardial infarction (MI) and repeat revascularization. When adequate LDL-C level is achieved, patients on a low-moderate-intensity statin dose have similar cardiovascular outcomes to those on high-intensity statins. Multivariable adjustment, propensity score matching, and inverse probability weighted analysis also produced the same results.
![high intensity statin list high intensity statin list](https://image.slidesharecdn.com/2013preventionguidelinescholesterolslideset-4-141025220109-conversion-gate02/95/2013-prevention-guidelines-cholesterol-slide-set-4-21-638.jpg)
The risk of MACE, however, was similar between the low-moderate- and high-intensity statin groups (HR, 0.917 95% CI: 0.760–1.107, P=0.368).
![high intensity statin list high intensity statin list](https://i1.rgstatic.net/publication/283046241_High-intensity_evidence_underpins_the_use_of_high-intensity_statins/links/5627691208aea4ef176d958d/largepreview.png)
Compared with the no statin group, both statin groups had significantly lower risk of MACE (low-moderate intensity: HR, 0.506 95% CI: 0.413–0.619, P<0.001 high intensity: HR, 0.464 95% CI: 0.352–0.611, P<0.001). Both low-moderate-intensity and high-intensity statin significantly reduced low-density lipoprotein cholesterol (LDL-C all P<0.001). The primary outcome was major adverse cardiac event (MACE) including cardiac death, non-fatal MI, and repeat revascularization at 1 year. Of these, a total of 12,182 patients, who completed 1-year follow-up, were included in this study, and all patients were classified into 3 groups (no statin low-moderate-intensity statin and high-intensity statin). The Korea Acute Myocardial Infarction Registry-National Institutes of Health consecutively enrolled 13,104 AMI patients. There has been debate regarding the added benefit of high-intensity statins compared with low-moderate-intensity statins, especially in patients with acute myocardial infarction (AMI). Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospitalĭepartment of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicineĭivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicineĭepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital National Maritime Medical Centerĭepartment of Cardiology, Yeungnam University Medical Centerĭepartment of Internal Medicine, Kyungpook National University HospitalĬardiology Division, Department of Internal Medicine, Chungbuk National University Hospitalĭepartment of Internal Medicine, Kyunghee University College of Medicineĭepartment of Internal Medicine and Heart Center, Chonnam National University Hospital