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Long-Term Benefit and Withdrawal Effect of Statins After Percutaneous Coronary Intervention: A Nationwide Population-Based Cohort Study

Authors Jeong HY, Lee SY, Kim SH, Kim J

Received 9 January 2020

Accepted for publication 3 March 2020

Published 5 April 2020 Volume 2020:14 Pages 717—724


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Hye Yun Jeong,1 So-Young Lee,1 Sang Hoon Kim,2,* Jinkwon Kim3,*

1Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea; 2Division of Cardiology, Department of Internal Medicine CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea; 3Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea

*These authors contributed equally to this work

Correspondence: Jinkwon Kim
Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Korea
Tel +82-31-5189-8152
Fax +82-31-5189-8208
Sang Hoon Kim
Division of Cardiology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Korea
Tel +82-31-780-5585
Fax +82-31-780-5857

Purpose: Despite indubitable evidence for the cardiovascular benefits of statins, there have been concerns that statin discontinuation may cause negative effects known as “statin withdrawal syndrome.” This study aimed to assess the benefit and the withdrawal effect of statins after percutaneous coronary intervention (PCI).
Patients and Methods: We conducted a retrospective cohort study on 5218 patients who underwent PCI between 2002 and 2013 using the nationwide health insurance claim data in Korea. Based on the prescription data, the use of statins during follow-up was classified into three risk periods: “statin period” (period with statin cover), “statin withdrawal period” (withdrawal of statin within 30 days), and “no statin period” (no exposure to statin for longer than 30 days). The primary outcome was the composite outcome of myocardial infarction, coronary revascularization, stroke, and all-cause death. We performed multivariate Cox proportional regression analyses which treated the use of statins as a time-dependent variable.
Results: During the follow-up period of 3.54 ± 2.91 years (mean ± standard deviation), 1515 (29.0%) patients sustained a primary outcome. Compared with the “no statin period,” the “statin period” was associated with lower risk of the primary outcome (adjusted hazard ratio [HR] 0.72, 95% confidence interval [CI, 0.63– 0.81]). While the “statin withdrawal period” posed a significantly increased risk (adjusted HR 1.87, 95% CI [1.52– 2.29]). With respect to the intensity of statins associated with withdrawal, dose-dependent increased risk was observed for withdrawal of low-, moderate-, and high-intensity statins; adjusted HR [95% CI] were 1.45 [0.74– 2.86], 1.86 [1.49– 2.32], and 2.61 [1.41– 4.81], respectively.
Conclusion: After PCI, there was an increased cardiovascular risk during the statin withdrawal period, especially with the use of high-intensity statins. To maximize the beneficial effect and to avoid the withdrawal effect of statins, high-risk patients need to adhere to taking statins without discontinuation.

Keywords: statin, percutaneous coronary intervention, statin withdrawal, adherence

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