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Early Statin Therapy and In-Hospital Outcomes in Acute Coronary Syndrome Patients Presenting with Advanced Killip Class at Admission: Findings from the CCC-ACS Project

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Abstract

Purpose

It is unknown if acute coronary syndrome (ACS) patients presenting with advanced Killip class (III/IV) would benefit from early statin therapy. Therefore, we aimed to explore the relationship between statin therapy within the first 24 h of medical contact and in-hospital outcomes in this patient population in a nationwide registry.

Method

In the Improving Care for Cardiovascular Disease in China—ACS project, among ACS patients presenting with Killip class III/IV, we performed the following three analyses: (i) the associations between early statin therapy and risks for in-hospital mortality and ischaemic events; (ii) the dose effect of statins on mortality and (iii) the interaction between low-density lipoprotein cholesterol (LDL-C) levels and statins on mortality.

Result

Among 104,516 ACS patients, 12,149 presented with advanced Killip class and 89.3% received early statins. Multivariable-adjusted logistic regression models revealed a 69% reduction in mortality in the statin group (adjusted odds ratio [OR] 0.31; 95% confidence interval [CI] 0.25–0.39), parallel with a reduction in ischaemic events (adjusted OR 0.50, 95% CI 0.33–0.74), compared with those not receiving early statins, which was consistent in multiple sensitivity analyses. Additionally, the protective association of early statins on in-hospital mortality was observed even among patients that received a low-to-moderate dose. Finally, the short-term survival benefit of early statins was independent of LDL-C.

Conclusion

In a nationwide ACS registry, statin therapy initiated within the first 24 h of medical contact was associated with a reduced risk of in-hospital mortality in ACS patients presenting with advanced Killip class.

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Acknowledgements

The authors thank all hospitals participating in the CCC-ACS project for their invaluable contribution to this work; see the electronic supplementary material, Table 6S.

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Authors and Affiliations

  1. Graduate School of Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, China

    Xiwen Song, Ziping Li, Haonan Sun, Hangkuan Liu & Geru A

  2. Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China

    Xiwen Song, Xin Zhou, Ziping Li, Haonan Sun, Hangkuan Liu, Geru A, Qing Yang & Yongle Li

  3. Department of Epidemiology and Cardiology, Beijing Anzhen Hospital, Capital Medical University, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China

    Yongchen Hao, Jing Liu, Jun Liu & Dong Zhao

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  1. Xiwen Song
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the CCC-ACS Investigators

Corresponding authors

Correspondence to Qing Yang or Yongle Li.

Ethics declarations

Ethics approval and consent to participate

The CCC-ACS project was approved by the institutional review board of Beijing Anzhen Hospital, Capital Medical University, with a waiver for informed consent.

Consent for publication

Not applicable.

Availability of data and materials

The data and study materials will be made available for onsite audits by third parties for the purposes of reproducing the results or replicating the procedure.

Code availability

Not applicable.

Competing interests

The authors have declared that no competing interests exist.

Funding

The CCC-ACS project is a collaborative project of the American Heart Association and the Chinese Society of Cardiology. The American Heart Association received funding from Pfizer through an independent grant for learning and change and AstraZeneca as a quality improvement initiative. This work was also supported by the National Key R&D Program of China (Nos. 2020YFC2004700, 2020YFC2004706).

Authors' contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XS. The first draft of the manuscript was written by XS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure of potential conflicts of interest

Xiwen Song, Xin Zhou, Ziping Li, Haonan Sun, Hangkuan Liu, Geru A, Yongchen Hao, Jing Liu, Jun Liu, Dong Zhao, Qing Yang and Yongle Li declare that they have no conflicts of interest.

Research involving Human Participants and/or Animals

This study involved human participants, with a waiver for informed consent.

Informed consent

Informed consent was waived for this study.

Additional information

A complete list of CCC-ACS investigators is given in the electronic supplementary material, Table 6S.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 603 kb)

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Song, X., Zhou, X., Li, Z. et al. Early Statin Therapy and In-Hospital Outcomes in Acute Coronary Syndrome Patients Presenting with Advanced Killip Class at Admission: Findings from the CCC-ACS Project. Am J Cardiovasc Drugs 22, 685–694 (2022). https://doi.org/10.1007/s40256-022-00546-5

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