Application of the very high risk criterion and evaluation of cholesterol guideline adherence in acute myocardial infarction patients at an urban academic medical center

Adam J Brownstein; Robert Derenbecker; Yumin Gao; Jie Ding; Bibin Varghese; Nino Isakadze; Erin M Spaulding; Francoise A Marvel; Seth S Martin

doi:10.1016/j.ahjo.2021.100082

Application of the very high risk criterion and evaluation of cholesterol guideline adherence in acute myocardial infarction patients at an urban academic medical center

Am Heart J Plus. 2022 Jan 5:13:100082. doi: 10.1016/j.ahjo.2021.100082. eCollection 2022 Jan.

Authors

Adam J Brownstein¹, Robert Derenbecker¹, Yumin Gao¹, Jie Ding¹, Bibin Varghese¹, Nino Isakadze^{1

2

3}, Erin M Spaulding^{2

4}, Francoise A Marvel^{1

2}, Seth S Martin^{1

2

3

5}

Affiliations

¹ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Johns Hopkins University School of Nursing, Baltimore, MD, USA.
⁵ Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.

Abstract

Objective: The 2018 AHA/ACC cholesterol guidelines recommend considering non-statin agents among very high-risk (VHR) patients with LDL-C ≥ 70 mg/dL after maximizing statin therapy. We aimed to evaluate the prevalence of VHR status in acute myocardial infarction (AMI) patients at hospital discharge and the adherence to guideline-directed cholesterol therapy (GDCT) within one-year follow-up post-AMI.

Methods: We performed a retrospective analysis of patients who suffered a type 1 AMI between October 2015 and March 2019, and then were followed at our institution for 1 year after hospital discharge. We calculated the percentage of patients at VHR and among those with follow up lipid panels, we determined the proportion able to achieve GDCT.

Results: The mean age of the 331 AMI patients was 61.0 (SD 11.9) years and 33.6% were women. Overall, 268 (81.0%) patients were categorized as having VHR at discharge. Among patients at VHR, a lipid panel was rechecked in 153 individuals (57.1%) within 1 year of discharge, with the median time to lipid recheck being 22.4 weeks (interquartile range: 10.9-40.7 weeks). Among those with a lipid panel re-check, 100 (65.4%) of patients achieved GDCT.

Conclusions: Approximately 4 out of 5 AMI patients were considered VHR per the 2018 AHA/ACC guidelines, only about half had follow up lipid panels in the year following AMI, and about two-thirds of those with follow up lipid panels achieved GDCT.

Keywords: Acute myocardial infarction; Cardiovascular risk; Cholesterol; Guidelines; Low-density lipoprotein lowering.