Résumé
Background and AimFamilial hypercholesterolemia (FH) carries an increased risk of coronary artery disease. Little is known on its prevalence and long-term prognostic significance in patients having sustained an acute myocardial infarction (AMI). The aim of this study was to assess 5-year outvcome of FH in patients with AMI included in the FAST-MI 2005 and 2010 registries.MethodsFAST-MI is a nationwide French registry programme including consecutive patients with AMI ≤ 48 hours of onset during a one-month period in most French institutions every 5 years since 2005; 5-year follow-up is available in >95% of patients for the 2005 and 2010 cohorts. An algorithm derived from the Dutch lipid clinic criteria was used to define probable or definite FH (FH+).ResultsFrom 7839 patients included, 5415 had a lipid profile assessed at admission, among whom FH could be estimated from the algorithm in 5292, and 5147 survived the initial hospital phase. The prevalence of FH was 2.8% (n=146), 2.5% in 2005 and 3.0% in 2010. FH+ patients were younger (53 ± 12 vs 65 ± 14 years, P<0.001), with a lower GRACE score (119 vs 142, P<0.001), and more family history of premature coronary artery disease (68.5% vs 25%, P<0.001). LDL at admission was 220 ± 70 vs 116 ± 39 mg/dl, P<0.001). FH+ patients received more statins at discharge than FH- patients (99% vs 90%, P<0.001). Five-year survival in patients surviving the initial hospital phase, was 87% in FH+ and 82% in FH- patients (P=0.11), and MACE-free survival was 81.5% and 79% respectively (P=0.57). After adjustment using a Cox proportional hazard model, however, 5-year mortality was significantly higher in FH+ patients (fully adjusted modelHR 1.82; 95%CI1.15-2.89, P=0.01), MACE-free survival was lower (HR 1.97, 1.34-2.88, P=0.001). Propensity score-matched cohorts showed a lower survival and MACE-free survival in HCF patients (87% vs 94%, P=0.005, and 82% vs 90%, P=0.002) (Figure).ConclusionFH was found in 2.8% of patients admitted for AMI; after adjustment on baseline parameters and discharge medications including statin dose at discharge, the risk of 5-year death and death or MACE was twice as high in FH compared with non-FH patients.