Based on moderate quality evidence , due to concerns about risk of bias and imprecision , initiation of statin therapy within 14 days following ACS does not reduce death , myocardial infa rct ion , or stroke up to four months , but reduces the occurrence of unstable angina at four months following ACS .
Serious side effects were rare
BACKGROUND The early period following the onset of acute coronary syndrome ( ACS ) represents a critical stage of coronary heart disease , with a high risk of recurrent events and deaths .
The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear .
This is an up date of a review previously published in 2011 .
OBJECTIVES To assess the effects , both harms and benefits , of early administered statins in patients with ACS , in terms of mortality and cardiovascular events .
Effect of fluvastatin on ischaemia following acute myocardial infarction: a randomized trial.
AIMS Residual ischaemia following acute myocardial infa rct ion ( AMI ) is related to an adverse outcome , although the effect of early initiation of statin therapy is unknown . METHODS A r and omized , placebo-controlled , double-blind , parallel study was performed , which compared fluvastatin 80 mg daily with placebo in patients with an AMI and total cholesterol of < 6.5 mmol.l(-1 ) . Ischaemia was measured by ambulatory electrocardiographic ( AECG ) monitoring over 48-h at baseline , after 6 weeks and at 12 months . RESULTS Five hundred and forty patients were included ( 83 % male , age 61+/-11 years ) ; 43 % had an anterior AMI and 50 % were treated with fibrinolytics in the acute phase . After 12 months , the total cholesterol ( TC ) level was reduced by 13 % and LDL-C ( low-density-lipoprotein cholesterol ) by 21 % ( from 3.5 mmol.l(-1 ) to 2.7 mmol.l(-1 ) ) in the fluvastatin treatment group . Both TC and LDL increased by 9 % in the placebo group ( P<0.001 between groups ) . At baseline , ischaemia on AECG was present in only 11 % of patients , and absent in 77 % ; in the remaining 11 % , recordings were technically inadequate . After 6 weeks , 32/48 ( 67 % ) , and 12 months 35/46 ( 76 % ) of the patients with ischaemia on the baseline AECG , no longer showed signs of ischaemia . Nevertheless , ischaemia at baseline was predictive for the occurrence of any major clinical event ( RR=2.35 ; 95 % CI 1.39 - 3.2;P < 0.001 ) . Fluvastatin treatment did not affect ischaemia on AECG , nor the occurrence of any major clinical events as compared to placebo . Post-hoc analysis in patients with the most pronounced ischaemia at baseline showed a trend for a beneficial effect of fluvastatin on major clinical events ( P=0.084 ) . CONCLUSION Residual ischaemia after AMI is observed less frequently in the present study , than in earlier studies , although it is predictive for future cardiovascular events . As a result , the present study was underpowered , and no effect of fluvastatin on AECG ischaemia , or major clinical events in the first year after AMI , could be detected . The present data do not confirm other reports which support widespread use of statin treatment early after AMI
Based on moderate quality evidence , due to concerns about risk of bias and imprecision , initiation of statin therapy within 14 days following ACS does not reduce death , myocardial infa rct ion , or stroke up to four months , but reduces the occurrence of unstable angina at four months following ACS .
Serious side effects were rare
BACKGROUND The early period following the onset of acute coronary syndrome ( ACS ) represents a critical stage of coronary heart disease , with a high risk of recurrent events and deaths .
The short-term effects of early treatment with statins on patient-relevant outcomes in patients suffering from ACS are unclear .
This is an up date of a review previously published in 2011 .
OBJECTIVES To assess the effects , both harms and benefits , of early administered statins in patients with ACS , in terms of mortality and cardiovascular events .