Does early initiation of statin therapy following the onset of acute coronary syndromes reduce the short-term risk of death, recurrent myocardial infarction, or stroke?

Early initiation of statin therapy within 14 days of the onset of acute coronary syndromes (ACS) does not reduce the risk of death, recurrent myocardial infarction (MI), or stroke up to 4 months. (LOE = 1a)

Briel M, Schwartz GG, Thompson PL, et al. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes. A meta-analysis of randomized controlled trials. JAMA 2006;295:2046-2056.  [PMID:16670413]

Meta-analysis (randomized controlled trials)

Industry

Various (meta-analysis)

During the initial period following the onset of ACS the risk is high for recurrent events and death due to vessel occlusions from vulnerable coronary plaques. To study the efficacy of statins in reducing the short-term risk of adverse clinical outcomes, these investigators thoroughly searched (without any language restrictions) electronic databases including the Cochrane Registry, reference lists of identified articles, recently published editorials, topical reviews, and they contacted authors of significant publications. Eligible trials fulfilled the following criteria: Randomized trial design comparing statin treatment with usual care; initiation of treatment within 14 days of onset of ACS; and follow-up for at least 30 days. Two authors independently assessed trial eligibility and quality. Twelve studies, comprising 13,024 individuals with a mean age ranging from 53 to 69 years, met inclusion criteria. Early statin therapy did not significantly reduce the risk of death, MI, or stroke at either 1 or 4 months following ACS. In addition, there were no significant risk reductions for secondary outcomes including total death, total MI, total stroke, cardiovascular death, fatal or nonfatal MI, or revascularization procedures. The authors found no evidence for heterogeneity among the studies (ie, the results were basically similar among all the trials). A formal analysis found little evidence for publication bias.