Introduction: Although statin thetapy is beneficial in the setting of acute coronary syndrome (ACS), a substantial proportion of patients with ACS still do not receive the guideline-recommended lipid management in contemporary practice.
Hypothesis: The low-density lipoprotein cholesterol (LDL-C) level on admission might affect patient management and subsequent outcome.
Methods: Consecutive 994 patients with ACS who underwent PCI were retrospectively analyzed. Patients who died within 30 days were excluded from our study. The study patients were first divided into two groups based on the LDL-C levels on admission. Each group was then further divided into those who were prescribed statins or not at hospital discharge. The primary endpoint was all-cause death. Additionally, we analyzed the serial changes of LDL-C within 1 year.
Results: Upon admission, decreased LDL-C (<100 mg/dL) was observed in 292 (29%) of 994 patients. The proportion of patients who were prescribed statins at discharge was significantly smaller in the group exhibiting baseline LDL-C <100 mg/dL than those exhibiting ≥100 mg/dL (57% vs. 77%, p <0.001). Multivariate Cox-proportional hazard analysis revealed that LDL-C <100 mg/dL on admission (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.02—2.22; p<0.05) and prescription of statin at discharge (HR, 0.52; 95% CI, 0.35—0.75; p <0.001) were associated significantly with all-cause death. Figure A presents the cumulative mortality during follow-up. Under these condition, increasing LDL-C levels were documented during follow-up in patients with admission LDL-C <100 mg/dL when no statin prescribed at discharge (79±16 to 95±28 mg/dL, p <0.001), whereas these remained unchanged when statins were prescribed at discharge (Figure B)
Conclusions: These results demonstrated that decreased LDL-C on admission in ACS led to less statin prescription, which could result in increased death, probably due to underestimation of the baseline LDL-C.