European Heart Journal Advance Access published online on July 4, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl125
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1 Atrium Medical Centre, Heerlen, The Netherlands
* To whom correspondence should be addressed. Aims Statins provide effective secondary prevention in cardiovascular disease. However, it remains uncertain how soon statins should be started after an acute coronary syndrome (ACS). Recently published trials suggest starting before discharge. We hypothesize that statins should be initiated without delay. Methods and results Data from a large cohort of 10 484 consecutive patients with an ACS were analysed. Of this cohort, 1426 first-time statin receivers and survivors of the first 24 h were compared with 6771 first-day survivors not receiving statin therapy. A propensity score for the likelihood of receiving statin therapy within 24 h was developed and used with other established risk factors in a multivariable analysis. There was a significantly reduced all-cause 7-day mortality in patients receiving early statin therapy [0.4 vs. 2.6%, unadjusted hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.08-0.37, adjusted HR 0.34, 95% CI 0.15-0.79]. Statistical significance was observed in patients presenting with STE-ACS (adjusted HR 0.17, 95% CI 0.04-0.70) and not in NSTE-ACS patients. However, no statistical evidence of heterogeneity in treatment effect was observed between these groups. Conclusion These data suggest that very early statin therapy is associated with reduced mortality in patients presenting with STE-ACS; however, these findings have to be confirmed by prospective, randomized controlled trials before firm treatment recommendations can be given.
Received September 27, 2005
Revised April 28, 2006
Accepted June 1, 2006
Clinical research
Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on acute coronary syndromes
Timo Lenderink 1,
Eric Boersma 2,
Anselm K. Gitt 3,
Uwe Zeymer 3,
Lars Wallentin 4,
Frans Van de Werf 5,
David Hasdai 6,
Shlomo Behar 7,
and
Maarten L. Simoons 2 *
2 Department of Cardiology, Thoraxcentre, Erasmus University Medical Center, Room H560, Dr Molewaterplein 40, 3015 GD Rotterdam, Rotterdam, The Netherlands
3 Klinikum der Stadt Ludwigshafen, Germany
4 University of Uppsala, Uppsala, Sweden
5 Gasthuisberg University Hospital, Leuven, Belgium
6 Rabin Medical Center, Petah Tikwa, Israel
7 Neufeld Cardiac Research Institute, Tel Hashomer, Israel
Maarten L. Simoons, E-mail: m.simoons{at}erasmusmc.nl
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