Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction

Background: the impact of the 2013 american college of cardiology/american heart association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (cvd) events is unclear.methods and results: we analyzed a prospective cohort of consecutive st-segment elevation myocardial infarction (stemi) patients from a regional stemi system with data on patient demographics,low-density lipoprotein cholesterol levels,cvd risk factors,medication use,and outpatient visits over the 2 years prior to stemi. we determined pre-stemi eligibility according to american college of cardiology/american heart association guidelines and the prior third report of the adult treatment panel guidelines. our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male),and 761 (71.7%) did not have known cvd prior to stemi. only 62.5% and 19.3% of individuals with and without prior cvd were taking a statin before stemi,respectively. in individuals not taking a statin,median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known cvd were low (108 [83,138]  mg/dl and 110 [87,133] mg/dl). for individuals not taking a statin,only 38.7% were statin eligible by atp iii guidelines. conversely,79.0% would have been statin eligible according to american college of cardiology/american heart association guidelines. less than half of individuals with (49.2%) and without (41.1%) prior cvd had seen a primary care provider during the 2 years prior to stemi.conclusions: in a large cohort of stemi patients,application of american college of cardiology/american heart association guidelines more than doubled pre-stemi statin eligibility compared with third report of the adult treatment panel guidelines. however,access to and utilization of health care,a necessity for guideline implementation,was suboptimal prior to stemi. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.