Very early initiation of statin therapy and mortality in patients with acute coronary syndrome

Abstract

Background: Current guidelines for the treatment of patients with acute coronary syndrome (ACS) recommend the use of statins before hospital discharge. However, the prognostic impact of an early initiation of treatment is uncertain.

Methods: We reviewed data from randomized controlled trials (RCTs) to test the hypothesis that differences in the time of initiation of statin therapy may be associated with differences in mortality after hospitalization for ACS. We extracted data from 10 RCTs which evaluated one-month mortality of patients early treated with statins (mean time of administration ≤ 72 h from hospitalization) compared to patients receiving placebo or standard care.

Results: Overall, 4030 patients were randomized to statin therapy and 4022 patients to the control group. The effect of statins on mortality was not significant (OR 0.81, 95% CI: 0.58–1.12; P = 0.198). The 10 trials were divided up by the mean time of initiation of statin therapy (day 1, day 2 and day 3). Statins reduced mortality when treatment was initiated in day 1 (OR 0.63, 95% CI: 0.41–0.99; P = 0.045), not in day 2 or day 3. There was no statistically significant interaction across the subgroups in the risk of mortality (P = 0.303).

Conclusions: In patients admitted to hospital for ACS, statins may reduce hospital mortality when treatment is initiated on the first day of hospitalization.

Keywords::

• Acute coronary syndrome
• meta-analysis
• HMG-CoA reductase inhibitors
• treatment
• prognosis

Acknowledgement

This study was funded in part by the Fondazione Umbra Cuore e Ipertensione—ONLUS, Perugia, Italy.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Appendix

Search strategy: ‘((‘Myocardial Infarction’(Mesh)) OR ( ‘Acute Coronary Syndrome/blood’(Mesh) OR ‘Acute Coronary Syndrome/chemically induced’(Mesh) OR ‘Acute Coronary Syndrome/classification’(Mesh) OR ‘Acute Coronary Syndrome/complications’(Mesh) OR ‘Acute Coronary Syndrome/diagnosis’(Mesh) OR ‘Acute Coronary Syndrome/diet therapy’(Mesh) OR ‘Acute Coronary Syndrome/drug therapy’(Mesh) OR ‘Acute Coronary Syndrome/economics’(Mesh) OR ‘Acute Coronary Syndrome/enzymology’(Mesh) OR ‘Acute Coronary Syndrome/epidemiology’(Mesh) OR ‘Acute Coronary Syndrome/ethnology’(Mesh) OR ‘Acute Coronary Syndrome/etiology’(Mesh) OR ‘Acute Coronary Syndrome/genetics’(Mesh) OR ‘Acute Coronary Syndrome/history’(Mesh) OR ‘Acute Coronary Syndrome/immunology’(Mesh) OR ‘Acute Coronary Syndrome/metabolism’(Mesh) OR ‘Acute Coronary Syndrome/microbiology’ (Mesh) OR ‘Acute Coronary Syndrome/mortality’(Mesh) OR ‘Acute Coronary Syndrome/nursing’(Mesh) OR ‘Acute Coronary Syndrome/pathology’(Mesh) OR ‘Acute Coronary Syndrome/physiopathology’(Mesh) OR ‘Acute Coronary Syndrome/ prevention and control’(Mesh) OR ‘Acute Coronary Syndrome/psychology’(Mesh) OR ‘Acute Coronary Syndrome/radiography’ (Mesh) OR ‘Acute Coronary Syndrome/radionuclide imaging’(Mesh) OR ‘Acute Coronary Syndrome/rehabilitation’ (Mesh) OR ‘Acute Coronary Syndrome/surgery’(Mesh) OR ‘Acute Coronary Syndrome/therapy’(Mesh) OR ‘Acute Coronary Syndrome/ultrasonography’(Mesh) OR ‘Acute Coronary Syndrome/urine’(Mesh) OR ‘Acute Coronary Syndrome/virology’(Mesh) )) AND (‘Hydroxymethylglutaryl-CoA Reductase Inhibitors’(Mesh) OR ‘Hydroxymethylglutaryl-CoA Reductase Inhibitors’ (Pharmacological Action))’