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Early Statin Treatment Following Heart Attack and 1-Year
Survival
The Scandinavian Simvastatin Survival Study and the Cholesterol and
Recurrent Events trial and the Long-Term Intervention with Pravastatin in
Ischaemic Disease trials have shown that treatment with coenzyme A
reductase inhibitors (Statins) initiated 3-6 months after a heart attack
reduces mortality in patients with elevated cholesterol levels. Statin
treatment also reduces the risk of subsequent coronary events in high-risk
patients with high cholesterol levels but without previous manifestations
of coronary artery disease. Even though there are indications that show
that early statin treatment initiated during the hospital stay would be
beneficial, the only clinical trial that his studied early statin
intervention in acute coronary syndromes is the recently completed but not
yet published Myocardial Ischemia Reductions with Aggressive Cholesterol
Lowering study. Therefore, the number of patients with acute myocardial
infarctions who are treated with statins while in the hospital varies from
hospital to hospital. This study investigated the relationship between
1-year mortality and statin treatment initiated before or at the time of
hospital discharge in a large cohort of unselected patients with acute
myocardial infarction admitted to the coronary care units of Swedish
hospitals during 1995-1998.
Data was collected from the Swedish Register of Cardiac Intensive Care
on patients admitted to the coronary care units of 58 Swedish hospitals in
1995-1998. Patients with a first recorded acute myocardial infarction who
were younger than 80 years of age and who were discharged alive from the
hospital, including 5.528 who received statins at or before discharge and
14,071 who did not. One-year mortality data were obtained from the Swedish
National Cause of Death Register.
At one year, unadjusted mortality was 9.3% (1307) deaths in the no-statin
group and 4.0% (219 deaths) in the statin treatment group was recorded. In
regression analysis adjusting for confounding factors and propensity score
for statin use, early statin treatment with associated with a reductions
in 1-year mortality (relative risk, 0.75; 95% confidence interval,
0.63-0.89; p=.001) in hospital survivors of acute myocardial infarction.
This reduction in mortality was similar among all subgroups based on age,
sex, baseline characteristics, previous disease manifestations, and
medications.
This test concluded that early initiation of statin treatment in
patients with acute myocardial infarction is associated with reduced
1-year mortality. Considering that the potential benefits seem substantial
and adverse effects few, these findings suggest that initiation of statin
treatment before or at the time of discharge should be recommended for
acute myocardial infarction survivors with a total cholesterol or
low-density cholesterol levels above the current guideline levels for
statin treatment as secondary prevention. These results also emphasized
the importance of implementing the results of randomized statin trials in
unselected acute myocardial infarction patients. |
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