Impact of statin usage patterns on outcomes after percutaneous coronary in-tervention in acute myocardial infarction：Korea Working Group on Myocar-dial Infarction registry （KorMI） study

Background The benefit of statin use after acute ST-segment elevation myocardial infarction （STEMI） has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention （PCI）. Methods This analysis of the Korea Working Group on Myocardial Infarction registry （KorMI） study included 3,584 STEMI patients （mean age, 63 ±13 years;male, 2,684, 74.9%） undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events （MACE：all-cause death, recurrent MI, and target lesion revascularization） were compared among patients grouped according to statin therapy timing：I, both during and after hospitalization （n=2,653, 74%）;II, only during hospita-lization （n=309, 8.6%）;III, only after discharge （n=157, 4.4%）;and IV, no statin therapy （n=465, 13%）. Mean follow-up duration was 234 ± 113 days. Results Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups Ⅲ and Ⅳ had the highest MACE rates （2.3%, 3.9%, 5.1%, and 4.9%for groups I-IV, respectively, P=0.004）. After adjusting for confounders, groups Ⅱ-Ⅳ had a higher MACE risk than group Ⅰ [hazard ratio （HR）：3.20, 95%confidence interval （95%CI）：1.31-7.86, P=0.011;HR：3.84, 95%CI：1.47-10.02, P=0.006;and HR：3.17, 95%CI：1.59-6.40, P=0.001;respectively]. Conclusions This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical prac-tice.

Effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

To evaluate the effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS) .Methods Patients with ACS underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) investigation.Patients with culprit vulnerable borderline lesions were enrolled.No coronary inter-vention was performed on these lesions.All the patients received atrovastatin therapy for 12 months and underwent clin-ical follow-up along with IVUS follow-up.Cross section area (CSA) of the targeted lesion,CSA of the reference arter-ies (extra elastic membrane) ,minimal lumen CSA,and plaque area were measured at baseline and follow-ups.Ad-verse events included recurrent angina,recurrent myocardial infarction,revascularization and death.Results No ad-verse events was reported during follow-up period.Compared with baseline data,the level of ApoB decreased signifi-cantly at the end of the study (0.589 ± 0.136 g /L vs 0.681 ± 0.132 g /L,P = 0.03) .Both the percent diameter steno-sis and the percent area stenosis detected by CAG displayed minimal change ((62.50 ± 10.21) % vs (54.79 ± 12.35) % ,P = 0.48 and (58.61 ± 8.36) % vs (48.18 + 10.56) % ,P = 0.78) .Detected by IVUS,the minimal lu-minal CSA of the targeted lesion increased significantly (6.32 ± 2.42 mm2 vs 5.63 ± 2.51 mm2,P < 0.01) ,the plaque area and CSA stenosis decreased (7.70 ± 2.19 mm2 vs 8.17 ± 2.55 mm2,P < 0.05 and 56.94 ± 8.47% vs 61.4 ± 110.34% ,P < 0.01) .A total of 25 soft plaques (50% ) transformed into fibrous plaque.Conclusions Atro-vastatin therapy stabilizes borderline vulnerable plaque and reverses atherosclerosis progression in patients with ACS.