• Shmuel Gottlieb, Shimon Kolker, Nir Shlomo, Shlomi Matetzky, Eran Leitersdorf, Amit Segev, Ilan Goldenberg, Dan Tzivoni, Giora Weisz, and Mady Moriel.
• Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel; Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. Electronic address: shmuelg@ekmd.huji.ac.il.
• Int. J. Cardiol. 2016 May 1; 210: 133-8.

BackgroundSTEMI is thought to occur as a result of a vulnerable coronary plaque rupture. Statins possess hypolipidemic and pleotropic effects that stabilize coronary plaque. We sought to determine the association between LDL-C levels, statin use prior to the index event on the type of acute coronary syndrome (ACS) presentation: STEMI vs. non-STEMI/unstable angina.MethodsData was drawn from the ACS Israeli Survey (ACSIS), a biennial prospective survey of ACS patients hospitalized in all CCU/Cardiology departments during 2002-2010.ResultsAmong 6790 patients, 2760 (41%) reported statin use prior to the index ACS event. The proportion of STEMI was significantly lower among statin treated vs. statin naive patients (36% vs. 57%, p<0.0001). At each LDL-C level, the proportion of STEMI was significantly lower only among statin treated patients (p<0.0001). LDL-C<70 mg/dL was associated with a lower proportion of STEMI only among statin treated but not among statin naive patients (33% vs. 57%, p<0.0001). Multivariate analysis revealed that statin use was independently associated with a lower probability of presenting with STEMI (ORadj=0.73, p=0.007), but not LDL-C<70 mg/dL (ORadj=1.13, p=0.32). Patients on high-intensity statin therapy (HIST) were less likely to present with STEMI as compared with low-intensity statin therapy (LIST) or statin naive patients (27%, 38%, 56%, respectively, p for trend <0.0001; HIST ORadj=0.28, p=0.01; LIST ORadj=0.48, p=0.026).ConclusionsAmong patients admitted with ACS, statin use but not LDL-C level, was associated with a lower probability of presenting with STEMI. Patients on HIST had the lowest likelihood of presenting with STEMI.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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