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08-12-2009 | Cardiometabolic | Article

Early statin initiation improves outcomes in ACS patients


Free abstract

MedWire News: Patients who are started on intensive statin therapy during hospitalization for acute coronary syndromes (ACS) have better long-term outcomes than those who receive standard care, an analysis of clinical trial data suggests.

Results of the Extended-ESTABLISH trial indicate that initiating atorvastatin after percutaneous coronary intervention (PCI) lowers the risk for major adverse cardiac and cerebrovascular events (MACCE) compared with more conservative treatment.

Extended-ESTABLISH was an observational follow-up of ESTABLISH (Early statin treatment in patients with acute coronary syndrome), a prospective, open-label, randomized, single-center trial of patients with ACS who had undergone successful PCI under intravascular ultrasound guidance.

In all, 180 patients were randomly assigned to receive either intensive lipid-lowering therapy (ie, atorvastatin 20 mg/day started immediately after PCI) or standard care (a lipid-lowering diet). At 6 months post-PCI all patients received statins.

The mean follow-up duration was 4.2 years, during which time MACCE (defined as all-cause death, recurrent ACS, or stroke) occurred in 16 patients in the atorvastatin group and 26 in the control group.

Writing in the journal Atherosclerosis, Katsumi Miyauchi (Juntendo University, Tokyo, Japan) and team report that the likelihood of event-free survival was significantly higher in the atorvastatin group than in the placebo group.

In multivariate analysis, early statin therapy was a significant independent predictor for MACCE, with an adjusted hazard ratio of 0.46. Interestingly, subgroup analysis indicated that the beneficial impact of early statin therapy on nonfatal cardiovascular events was greater in patients with a high low-density lipoprotein cholesterol level at baseline.

“The present study extends and strengthens the benefits of statins with respect to long-term outcomes among ACS patients after revascularization,” write Miyauchi and co-authors.

“We postulate that early statin therapy is warranted for all patients with ACS even under the current guidelines, as the likely outcome can be predicted primarily from lipid profiles.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Joanna Lyford