Effects of Early Treatment With Statins on Short-term Clinical Outcomes in Acute Coronary Syndromes

Briel, Matthias; Schwartz, Gregory G.; Thompson, Peter L.; Lemos, James A. de; Blazing, Michael A.; Es, Gerrit‐Anne van; Kayıkçıoğlu, Meral; Arntz, Hans-Richard; Hartog, Frank R. den; Veeger, Nic; Colivicchi, Furio; Dupuis, Jocelyn; Okazaki, Shinya; Wright, R. Scott; Bucher, Heiner C.; Nordmann, Alain

doi:10.1001/jama.295.17.2046

Cited by 148 publications

(78 citation statements)

References 47 publications

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“…Some of the studies also report the reduction in markers of myocardial necrosis or inflammation in statin treatment in patient groups undergoing PCI. One meta-analysis (LOE 1) 646 and 2 other studies (LOE 4) 647,648 were neutral with regard to death and nonfatal myocardial infarction during the 30-day followup. There were no reports on the risk or safety considerations of early initiation of statin treatment in ACS.…”

Section: Consensus On Sciencementioning

confidence: 94%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

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103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Section: Consensus On Sciencementioning

confidence: 94%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

Self Cite

103

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“…Of these inflammatory biomarkers, CRP, WBC and ferritin are artery disease [8][9][10] . Recent meta-analyses have also demonstrated that statins reduce death, recurrent myocardial infarction and stroke in patients with acute coronary artery disease 11,12) . Both clinical and community-based studies have shown the role of statins in reducing important inflammatory markers such as CRP and WBC 2,4,[13][14][15] ; however, the effect of statins on the inflammatory response in the general population has not been reported for a nationally representative sample.…”

Section: Introductionmentioning

confidence: 99%

Effects of Statins on Serum Inflammatory Markers: The U.S. National Health and Nutrition Examination Survey 1999-2004

Yoon

Dillon

Carroll

et al. 2010

JAT

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“…The presence of myocardial ischemia is a marker for high risk of cardiac events and death. [2][3][4][5][6][7][8][9] Monitoring changes in frequency and duration of ischemia by ambulatory ECG may provide a means to assess the effectiveness of therapeutic interventions.…”

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confidence: 99%

Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease

et al. 2007

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Background-Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes. Methods and Results-A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with Ն1 episode of myocardial ischemia that lasted Ն3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both PϽ0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; Pϭ0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; Pϭ0.014). Conclusions-Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterollowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy. (Circulation. 2007;115:700-707.)

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Effects of Early Treatment With Statins on Short-term Clinical Outcomes in Acute Coronary Syndromes

Abstract: Based on available evidence, initiation of statin therapy within 14 days following onset of ACS does not reduce death, MI, or stroke up to 4 months.

Cited by 148 publications

References 47 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Effects of Statins on Serum Inflammatory Markers: The U.S. National Health and Nutrition Examination Survey 1999-2004

Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease

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