Abstract 14994: Discontinuation of Statins and Adverse Clinical Outcomes Post Percutaneous Coronary Intervention.

Introduction: Statin treatment reduces cardiovascular morbidity and mortality in those with and at risk of cardiovascular disease (CVD) and is endorsed in all major clinical guidelines for the prevention of CVD. Despite the weight of high quality evidence supporting benefits of treatment versus relatively rare serious side effects, the use of statins remains variable in clinical practice with high discontinuation rates reported for a treatment intended to be life-long. Our objectives were to determine (i) the rate of discontinuation of statin prescription (attrition) post-PCI, (ii) clinical factors associated with attrition, (iii) the risk of adverse events associated with attrition. Methods: We studied 3,478 patients (2011-2105) who were prescribed a statin post-Percutaneous Coronary Intervention (PCI) within a retrospective observational cohort using linked anonymised primary care and hospital health record data, including any record of ongoing statin prescription. Relationships between attrition and major clinical outcomes (death, acute coronary syndromes, revascularisation or stroke) were evaluated over 18-month follow up. Results: Cumulative attrition of statin prescription in the first six quarters post-PCI was 2.4%, 4.7%, 6.6%, 8.3%, 9.6% and 11.2% respectively. Heart failure and age ≥70y were independent predictors of attrition. 587 (16.9%) patients had an outcome-event during the follow up period. In a time-dependent multiple Cox regression model, statin attrition (HR=6.65, p <0.001), hypertension (HR=1.29, p=0.004), diabetes (HR=1.27, p= 0.01), previous MI (HR=1.42, p <0.001), ischaemic stroke (HR=1.42 p=0.005), thromboembolism (HR= 1.89, p= 0.038), Atrial Fibrillation (HR=1.30, p=0.018) and age ≤49 (HR=1.73, p=0.002) and age ≥70 (HR=1.88, p <0.001) vs reference age 50-59y were independently associated with adverse clinical outcomes. Conclusions: Attrition from statin therapy is lower than previously reported in the first 18-months post-PCI. However, despite this low rate of statin attrition, it is still independently associated with a high risk of adverse outcomes. [ABSTRACT FROM AUTHOR]