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Association of statin therapy with outcomes of acute coronary syndromes: the GRACE study

Authors :
Spencer, Frederick A.
Allegrone, Jeanna
Goldberg, Robert J.
Gore, Joel M.
Fox, Keith A.A.
Granger, Christopher B.
Mehta, Rajendra H.
Brieger, David
Source :
Annals of Internal Medicine. June 1, 2004, Vol. 140 Issue 11, p857, 10 p.
Publication Year :
2004

Abstract

Background: Statins administered early in patients with acute coronary syndromes may lead to modest reductions in recurrent ischemic events. Objective: To examine the association between previous and early in-hospital statin therapy and the presentation and outcomes of an acute coronary syndrome. Design: Cohort study. Setting: 94 hospitals in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE). Patients: 19 537 patients with an acute coronary syndrome who were enrolled from April 1999 to September 2002. Measurements: Statin use before and after presentation with an acute coronary syndrome and associated rates of myocardial infarction, hospital complications, and hospital mortality. The composite end point included death, in-hospital myocardial infarction, and stroke. Results: Patients who were already taking statins when they presented to the hospital were less likely to have ST-segment elevation (odds ratio [OR], 0.79 [95% CI, 0.71 to 0.88]) or myocardial infarction (OR, 0.78 [CI, 0.70 to 0.86]). Patients who continued to take statins in the hospital were less likely to experience complications or die than patients who never received statins (OR, 0.66 [CI, 0.56 to 0.77]). Patients not previously taking statins who began statin therapy in the hospital were less likely to die than patients who never received statin therapy (OR, 0.38 [CI, 0.30 to 0.48]). However, adjustment for the hospital of admission attenuated the association between initiation of statin therapy and the composite end point (OR, 0.84 [CI, 0.65 to 1.10]). Limitations: This observational study cannot exclude confounding by clinical and hospital factors. Conclusions: These data support the hypothesis that statin therapy can modulate early pathophysiologic processes in patients with acute coronary syndromes. A randomized trial of statin therapy in acute myocardial infarction is warranted.

Details

Language :
English
ISSN :
00034819
Volume :
140
Issue :
11
Database :
Gale General OneFile
Journal :
Annals of Internal Medicine
Publication Type :
Periodical
Accession number :
edsgcl.117783737