Prehospital statin therapy and one-year mortality in patients with stable coronary artery disease undergoing percutaneous coronary intervention

Background: Statins have multiple effects in patients with coronary artery disease. No studies have investigated whether chronic statin pretreatment before percutaneous coronary intervention (PCI) has an impact on long-term mortality in patients with stable angina. Methods: The study included 8041 patients with stable angina. At the time of PCI, 5939 patients (73.8%) were receiving statins for ≥ 1 month before procedure and 2102 patients (26.2%) were not receiving statins. The primary outcome analysis was 1-year mortality. Results: There were 192 deaths during the follow-up: 119 deaths among patients receiving statins and 73 deaths among patients not receiving statins (Kaplan-Meier estimates of 1-year mortality 2.06% and 3.59%; unadjusted hazards ratio [HR] = 0.56, 95% confidence interval [CI] 0.42-0.75; P < 0.001). Landmark analysis showed that almost all mortality benefit occurred in the first 30-days after PCI: 10 deaths among patients receiving statins and 22 deaths among patients not receiving statins (Kaplan-Meier estimates of 30-day death, 0.17% and 1.06%, respectively; HR = 0.16, 95% CI 0.08-0.34, P < 0.001). No significant difference in mortality according to statin pretreatment between 30 days and 1 year was observed (109 deaths among patients receiving statins vs 51 deaths among patients not receiving statins; Kaplan-Meier estimates 1.89% and 2.53%; HR = 0.75, 95% CI 0.53-1.05, P = 0.095). After adjustment in the Cox proportional hazards model, statin pretreatment was associated with a 35% reduction in the adjusted risk for 1-year mortality (adjusted HR = 0.65, 95% CI 0.44-0.98, P = 0.039). Conclusions: Pretreatment with statins before PCI was associated with a significant reduction of 1-year mortality in patients with stable angina.