Abstract 3083: Long Term Benefit of Statin Therapy Initiated During Acute Coronary Syndromes: A Meta-Analysis of Randomized Trials
Introduction: Initiation of statin therapy during acute coronary syndromes has not been shown to reduce mortality, myocardial infarction or stroke with up to 4 months of follow-up.
Hypothesis: We sought to evaluate the long term impact of statin therapy initiated during acute coronary syndromes compared to less intensive lipid reduction on all cause mortality and other adverse cardiac outcomes.
Methods: Studies were obtained from the MEDLINE database from 1996 to 2006 that randomized patients to statin therapy during an acute coronary syndrome compared to less intensive lipid reduction (placebo / lower-dose statin / usual care), and at least 6 months of follow-up were available.
Results: In all, there were 7 studies (L-CAD, PTT, FLORIDA, Colivicchi et al, PROVE-IT, ESTABLISH, and A to Z) with 9,553 patients. Statin therapy was given within 12 days of hospital presentation. The weighted mean duration of follow-up was 23 months. Among those who received statin therapy, total cholesterol was reduced 21% to 165 mg/dL (p=0.0006), while LDL was reduced 35% to 86 mg/dL (p<0.0001). For those who received less intensive lipid reduction, total cholesterol (207 mg/dL) and LDL cholesterol (129 mg/dL) were unchanged during follow-up (p=0.71 and p=0.23, respectively). The incidence of all cause mortality was 3.4% in the statin group versus 4.6% in the less intensive group (RR=0.74, 95%CI 0.61– 0.90, p=0.003). The number of patients needed to treat to prevent 1 death was 84 patients. Similarly, the incidence of cardiovascular mortality was 2.4% versus 3.3% (RR=0.74, 0.58 – 0.93, p=0.010), unstable angina was 4.1% versus 5.0% (RR=0.81, 0.68 – 0.98, p=0.027), revascularization was 11.1% versus 12.9% (RR=0.86, 0.78 – 0.96, p=0.006), stroke was 1.1% versus 1.2% (RR=0.90, 0.62–1.30, p=0.56), and myocardial infarction was 6.6% versus 7.0% (RR=0.94, 0.81–1.09, p=0.41).
Conclusions: Initiation of statin therapy during acute coronary syndromes improves long term survival, compared to less intensive lipid reduction. Relatively few patients need to be treated to prevent 1 death over a 23 month period. Furthermore, this approach significantly reduces unstable angina and the need for revascularization.