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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.

Xiaozhi Chen, Hangkuan Liu, Linjie Li, Geru A, Pengfei Sun, Doreen Su-Yin Tan, Mark Yan-Yee Chan, Roger Sik-Yin Foo, Gregg C Fonarow, Qing Yang and 1 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

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.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
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  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Xiaozhi Chen *Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Hangkuan Liu *Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Linjie LiDepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Geru ADepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Pengfei SunDepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China.
Doreen Su-Yin TanDepartment of Pharmacy and Pharmaceutical Sciences, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
Mark Yan-Yee ChanDepartment of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
Roger Sik-Yin FooDepartment of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
Gregg C FonarowDivision of Cardiology, David Geffen School of Medicine, University of California, Geffen Hall 885 Tiverton Drive, Los Angeles, CA, 90095, USA.
Qing YangDepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China. cardio-yq@tmu.edu.cn.
Xin ZhouDepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, 154, Anshan Road, Heping District, Tianjin, 300052, China. xinzhou@tmu.edu.cn.ORCID http://orcid.org/0000-0003-1395-7103

Funding

National Natural Science Foundation of China 72274133National Natural Science Foundation of China 72304205National Natural Science Foundation of China 82320108001National Natural Science Foundation of China 82321001Tianjin Key Medical Discipline (Specialty) Construction Project TJYXZDXK-069C
6 · The paper itself

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.

Indexed as

AtorvastatinMyocardial InfarctionPercutaneous Coronary InterventionRosuvastatin CalciumAgedCause of DeathChinaFemaleHospital MortalityHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedTreatment OutcomeAtorvastatinHydroxymethylglutaryl-CoA Reductase InhibitorsRosuvastatin CalciumAtorvastatinElevated liver enzymesMortalityMyocardial infarctionRosuvastatin

Identifiers

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.