A Propensity Score Matched Analysis of Statin Effects on Major Adverse Cardiac Events after Percutaneous Coronary Intervention in Patients Over 75 Years Old

Takeo Horikoshi; Takamitsu Nakamura; Toru Yoshizaki; Jun Nakamura; Yosuke Watanabe; Manabu Uematsu; Aritaka Makino; Yukio Saito; Jun-ei Obata; Takao Sawanobori; Hajime Takano; Ken Umetani; Akinori Watanabe; Tetsuya Asakawa; Akira Sato; Kiyotaka Kugiyama

doi:10.2169/internalmedicine.8932-21

ORIGINAL ARTICLES

A Propensity Score Matched Analysis of Statin Effects on Major Adverse Cardiac Events after Percutaneous Coronary Intervention in Patients Over 75 Years Old

Takeo Horikoshi, Takamitsu Nakamura, Toru Yoshizaki, Jun Nakamura, Yosuke Watanabe, Manabu Uematsu, Aritaka Makino, Yukio Saito, Jun-ei Obata, Takao Sawanobori, Hajime Takano, Ken Umetani, Akinori Watanabe, Tetsuya Asakawa, Akira Sato, Kiyotaka Kugiyama

Author information

Takeo Horikoshi
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Takamitsu Nakamura
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Toru Yoshizaki
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Jun Nakamura
Department of Cardiology, Fujieda Municipal General Hospital, Japan
Yosuke Watanabe
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Manabu Uematsu
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Aritaka Makino
Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Japan
Yukio Saito
Department of Cardiology, Kofu Municipal Hospital, Japan
Jun-ei Obata
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Takao Sawanobori
Department of Cardiology, Kofu Municipal Hospital, Japan
Hajime Takano
Department of Cardiology, Kofu Jonan Hospital, Japan
Ken Umetani
Department of Internal Medicine, Yamanashi Prefectural Central Hospital, Japan
Akinori Watanabe
Department of Cardiology, Fujieda Municipal General Hospital, Japan
Tetsuya Asakawa
Department of Cardiology, Yamanashi Kosei Hospital, Japan
Akira Sato
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan
Kiyotaka Kugiyama
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, Japan

Keywords: aging, cardiovascular diseases, mortality, percutaneous coronary intervention, statin

JOURNAL OPEN ACCESS
Supplementary material

2022 Volume 61 Issue 18 Pages 2711-2719

DOI https://doi.org/10.2169/internalmedicine.8932-21

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Abstract

Objective In an extremely aging society, it is beneficial to reconsider the value of medical treatment for extremely elderly patients. We therefore focused on the efficacy of statin therapy in extremely elderly patients. This study investigated the efficacy of statins for secondary prevention in patients over 75 years old.

Methods This prospective multicenter registry included 1,676 consecutive extremely elderly patients with coronary artery disease who underwent successful percutaneous coronary intervention (PCI). The patients were followed up clinically for up to three years or until the occurrence of major adverse cardiac events (MACEs), defined as a composite of all-cause death and non-fatal myocardial infarction. Using propensity score methodology to eliminate selection bias, in a 1:1 matching ratio, we selected 466 pairs of patients for the analysis.

Results During the median follow-up period of 25 months, MACEs occurred in 176 patients. The Kaplan-Meier analysis showed that statin treatment correlated with a lower probability of initial MACE occurrences within 30 days compared with no statin treatment (log-rank test, p<0.001). According to a landmark analysis at day 30, statin treatment still showed consistent effectiveness for reducing MACE occurrence during the follow up period (p=0.04). A multivariable Cox hazard analysis showed that statin therapy significantly reduced MACE occurrence (hazard ratio 0.55 [0.40-0.75], p<0.001). In the stratification analysis, statin therapy was especially beneficial in patients without symptomatic heart failure.

Conclusion Statins were effective in preventing MACEs in extremely elderly patients after PCI.

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