Different impacts of statin treatment on development of ischemic heart failure after acute myocardial infarction in patients with or without renal dysfunction
Purpose: It remains unclear whether statin treatment benefits the patients with heart failure in terms of clinical outcomes Also there is a controversy whether patients with renal dysfunction (RD) develops ischemic heart failure (IHF) after acute myocardial infarction (AMI) more easily than those without RD. The aim of this study was to evaluate the effectiveness of statin treatment on IHF in patients with RD.

Methods: A total of 36,580 patients with AMI were enrolled in nationwide AMI registry between November 2005 and February 2012. Of these, eligible 6,835 AMI patients (65.3±12.9 years, 74% Men) with (n=2,209) or without RD (n=4,626) were extracted and divided into two subgroups according to statin treatment (statin group: n=5,133, non-statin group: n=1,702). Primary end point was development of IHF assessed by follow-up echocardiography. IHF was defined by reduced left ventricular ejection fraction (<50%) and wall motion abnormality in territories consistent with coronary angiographic findings.

Results: Baseline characteristics were not significantly different between groups. In COX proportional regression analysis, RD was an independent predictor of IHF (HR 1.482, 95% CI 1.340-1.640, p <0.0001) along with advanced age. In Kaplan-Meier analysis, non-statin group showed more IHF development in patients with RD than without at short- and long-term follow-up (p <0.0001 by log-rank test). However, statin group showed no difference between patients with and without RD at short-term follow-up and late development of IHF after AMI (p <0.0001 by log-rank test).

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Conclusions: Statin treatment of AMI patients with renal dysfunction may prevent early development of IHF. Large randomized controlled trials and future investigations of how to reduce late one are warranted.

 [1]: pending:yes