Stratification Analysis of Statin Effect on Major Adverse Cardiac Events after Percutaneous Coronary Intervention in Patients on Hemodialysis.

ABSTRACT The statin use in patients on hemodialysis remains controversial and no beneficial effects of statin on the reduction of adverse cardiovascular events have been reported in these patients. This study used stratification analysis to examine the clinical factors in patients on hemodialysis who could benefit from statin for secondary prevention. This prospective multicenter study included 234 consecutive patients on hemodialysis with coronary artery disease who underwent successful reperfusion therapy with percutaneous coronary intervention (PCI). The patients were followed-up for up to 3 years or until the occurrence of major adverse cardiac events (MACE; defined as a composite of all-cause death and non-fatal myocardial infarction). Inverse probability of treatment weighting (IPTW) adjustment was used to remove the selection bias. During the median follow-up period of 30 months, MACE occurred in 55 patients. Patients with MACE had significantly lower statin therapy (P < 0.001). Multivariable Cox proportional hazards analysis showed that the patients on statins had significantly reduced rate of MACE occurrence (adjusted hazard ratio 0.30 [0.11-0.81], P = 0.02). The stratification analysis of outcomes according to the presence of clinical factors showed that beneficial effects of statin were associated with male, elderly, lower body mass index, lower abdominal circumference, hypertension, diabetes, higher C-reactive protein, symptomatic heart failure, lower left ventricular function, non-acute coronary syndrome, and shorter stent length. Statin was effective for the prevention of MACEs in patients on hemodialysis who underwent PCI. We identified specific clinical factors affecting statin effectiveness for secondary prevention.