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Starting Statins Early During Acute Coronary Syndrome May Improve Survival: Presented at SCAI

By Crystal Phend

CHICAGO, I.L. -- May 15, 2006 -- Early, aggressive statin therapy during an acute coronary syndrome (ACS) appears to significantly improve survival and reduce subsequent unstable angina as well as the need for revascularization, according to a meta-analysis presented here at the Society for Cardiovascular Angiography and Interventions annual meeting (SCAI).

"Aggressive statin therapy initiated early during an ACS results in a significant survival benefit with a favorable number needed to treat to prevent 1 death," said lead author Anthony A. Bavry, MD, MPH, cardiovascular medicine fellow, Cleveland Clinic Foundation, Cleveland, Ohio.

Although early statin use during ACS has recently begun to be evaluated, most clinical trials have only shown a reduction in composite cardiac outcomes without being statistically powered to show a difference in individual outcomes or mortality, Dr. Bavry said in a presentation May 11^th.

The meta-analysis looked at 9 randomized clinical trials that initiated aggressive statin therapy in a total of 16,076 patients with ACS 6 hours to 12 days after presentation with ACS.

Three of the trials used atorvastatin, 1 used simvastatin, 4 used pravastatin and 1 used fluvastatin. In the studies, 44% to 100% of the patients had a myocardial infarction (MI) at enrollment. The average age ranged from 52 to 69 years.

Cumulatively total cholesterol was reduced by 34% in the aggressive arm from a baseline of 221 mg/dL compared to 5% in the non-aggressive arm from a baseline of 211 mg/dL. Low-density lipoprotein (LDL) cholesterol was also significantly reduced by aggressive statin therapy compared to non-aggressive statin therapy.

High-sensitivity C-reactive protein levels were reduced by 89% in the aggressive arm versus 84% in the conservative arm, which just missed statistical significance, in the 3 trials that looked at this measure.

The relative risk reduction favoring aggressive, early statin use was 22% for all-cause mortality, 25% for cardiovascular mortality, 16% for unstable angina requiring hospital admission, and 9% for revascularization. There was a trend to a reduction in stroke and MI, but these were not significant differences.

By 15 months, 111 patients needed to be treated with early, aggressive statin therapy to prevent 1 death. The number needed to treat to prevent 1 revascularization was 81 and 93 patients needed to be treated to prevent 1 case of recurrent angina.

A sub-analysis showed no significant difference in all-cause mortality by the type of statin used or whether or not patients were started on aggressive therapy within 72 hours of presentation.

Dr. Bavry said there was no evidence for heterogeneity or publication bias in the studies.


[Presentation title: Benefit of Early Statin Therapy During Acute Coronary Syndromes: A Meta-Analysis. Abstract O-9]

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