Background:
Statins administered early in patients with acute coronary syndromes may lead to modest reductions in recurrent ischemic events.
Objective:
To examine the association between previous and early in-hospital statin therapy and the presentation and outcomes of an acute coronary syndrome.
Design:
Cohort study.
Setting:
94 hospitals in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE).
Patients:
19 537 patients with an acute coronary syndrome who were enrolled from April 1999 to September 2002.
Measurements:
Statin use before and after presentation with an acute coronary syndrome and associated rates of myocardial infarction, hospital complications, and hospital mortality. The composite end point included death, in-hospital myocardial infarction, and stroke.
Results:
Patients who were already taking statins when they presented to the hospital were less likely to have ST-segment elevation (odds ratio [OR], 0.79 [95% CI, 0.71 to 0.88]) or myocardial infarction (OR, 0.78 [CI, 0.70 to 0.86]). Patients who continued to take statins in the hospital were less likely to experience complications or die than patients who never received statins (OR, 0.66 [CI, 0.56 to 0.77]). Patients not previously taking statins who began statin therapy in the hospital were less likely to die than patients who never received statin therapy (OR, 0.38 [CI, 0.30 to 0.48]). However, adjustment for the hospital of admission attenuated the association between initiation of statin therapy and the composite end point (OR, 0.84 [CI, 0.65 to 1.10]).
Limitations:
This observational study cannot exclude confounding by clinical and hospital factors.
Conclusions:
These data support the hypothesis that statin therapy can modulate early pathophysiologic processes in patients with acute coronary syndromes. A randomized trial of statin therapy in acute myocardial infarction is warranted.
*For a list of the members of the GRACE Scientific Advisory Committee, see the Appendix.
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Author, Article, and Disclosure Information
From University of Massachusetts Medical School, Worcester, Massachusetts; The University and The Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Duke University Medical Center, Durham, North Carolina; University of Michigan, Ann Arbor, Michigan; and Concord Hospital, Sydney, Australia.
Grant Support: GRACE is supported by an unrestricted educational grant from Aventis Pharma, Bridgewater, New Jersey.
Disclosures:Honoraria: K.A.A. Fox (Aventis, Bristol-Myers Squibb/Sanofi); Grants received: K.A.A. Fox (Aventis, Bristol-Myers Squibb/Sanofi), C.B. Granger (Aventis, Bristol-Myers Squibb/Sanofi, Organon, Novartis, AstraZeneca).
Corresponding Author: Frederick A. Spencer, MD, Department of Medicine/Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655; e-mail, [email protected]
Current Author Addresses: Drs. Spencer, Goldberg, and Gore and Ms. Allegrone: Department of Medicine/Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.
Dr. Fox: The Royal Infirmary of Edinburgh, Department of Cardiology, Edinburgh, Scotland EH3 9WY, United Kingdom.
Dr. Granger: Duke University Medical Center, 2400 Pratt Street, Room 0311, Terrace Level, Box 3409, Durham, NC 27705.
Dr. Mehta: University of Michigan Health System, Division of Cardiology, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0366.
Dr. Brieger: Concord Repatriation Hospital, Coronary Care Unit, Level 3, Multi Building, Hospital Road, Concord NSW 2139, Australia.
Author Contributions: Conception and design: F.A. Spencer, J.M. Gore, C.B. Granger.
Analysis and interpretation of the data: F.A. Spencer, J. Allegrone, R.J. Goldberg, J.M. Gore, K.A.A. Fox.
Drafting of the article: F.A. Spencer, R.J. Goldberg.
Critical revision of the article for important intellectual content: F.A. Spencer, R.J. Goldberg, J.M. Gore, K.A.A. Fox, C.B. Granger, R.H. Mehta, D. Brieger.
Final approval of the article: F.A. Spencer, J. Allegrone, R.J. Goldberg, J.M. Gore, K.A.A. Fox, C.B. Granger, R.H. Mehta, D. Brieger.
Provision of study materials or patients: R.H. Mehta, D. Brieger.
Statistical expertise: J. Allegrone.
Obtaining of funding: J.M. Gore.
Administrative, technical, or logistic support: J.M. Gore.
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