ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Atorvastatin versus rosuvastatin in acute myocardial infarction with elevated liver enzymes: a target trial emulation study.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Burden of Systemic Inflammation Among Individuals with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease in Northern China.Cardiology and therapy · 2026Article
- Safety and effectiveness of dabigatran vs rivaroxaban in nonvalvular atrial fibrillation patients at nutritional risk.Research and practice in thrombosis and haemostasis · 2026Article
- Low-intensity versus moderate- to high-intensity lipid-lowering therapy after myocardial infarction in patients aged 80 years and older: A retrospective cohort study.American journal of preventive cardiology · 2026Article
- Remnant Cholesterol and Prognostic Outcomes in Patients With Atrial Fibrillation on Oral Anticoagulants.Journal of the American Heart Association · 2025Article
- A Comprehensive Review of the Latest Approaches to Managing Hypercholesterolemia: A Comparative Analysis of Conventional and Novel Treatments: Part I.Life (Basel, Switzerland) · 2025Review
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Authors and funding
11 authors.
Funding
Abstract
backgroundStatins are associated with liver-related adverse events, with risk varying by statin type. However, current guidelines lack specific recommendations for statin selection in acute myocardial infarction (AMI) patients with elevated liver enzymes.
methodsThis cohort study used a target trial emulation approach to include AMI patients treated with percutaneous coronary intervention between 2013 and 2022 from the Tianjin Health and Medical Data Platform, China. Eligible patients with atorvastatin or rosuvastatin prescriptions during hospitalization were matched 1:1 using propensity scores in those with elevated liver enzymes and normal liver enzymes respectively, and tracked for 1 year or until death (intention-to-treat analysis). Nonadherent patients were censored in the per-protocol analysis. The primary outcome was 1-year all-cause mortality, with secondary outcomes including recurrent MI and stroke.
resultsIn a matched cohort of 25,728 patients with elevated liver enzymes, 614 deaths (2.4%) occurred. Atorvastatin was associated with higher all-cause mortality compared to rosuvastatin (hazard ratio [HR]: 1.29, 95% confidence interval [CI] 1.10-1.51), consistent in the per-protocol analysis, and the in-hospital mortality difference was confirmed in an independent cohort. No significant differences were observed for recurrent MI (HR: 0.98, 95% CI 0.87-1.11) or stroke (HR: 1.10, 95% CI 0.93-1.28). Similar target trial emulation design among 18,270 AMI patients with normal liver enzymes at admission (9135 per group) found no significant differences between the two statins in all-cause mortality (HR: 1.09, 95% CI 0.88-1.35), recurrent MI (HR: 1.05, 95% CI 0.90-1.23), or stroke (HR: 1.07, 95% CI 0.90-1.28).
conclusionsAtorvastatin treatment was associated with a higher risk of 1-year all-cause mortality than Rosuvastatin in a target trial emulation study of patients with elevated liver enzymes following AMI.
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Registered trials
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