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 .
Early invasive versus selectively invasive management for acute coronary syndromes.
BACKGROUND Current guidelines recommend an early invasive strategy for patients who have acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level . However , r and omized trials have not shown an overall reduction in mortality , and the reduction in the rate of myocardial infa rct ion in previous trials has varied depending on the definition of myocardial infa rct ion . METHODS We r and omly assigned 1200 patients with acute coronary syndrome without ST-segment elevation who had chest pain , an elevated cardiac troponin T level ( > or = 0.03 mug per liter ) , and either electrocardiographic evidence of ischemia at admission or a documented history of coronary disease to an early invasive strategy or to a more conservative ( selectively invasive ) strategy . Patients received aspirin daily , enoxaparin for 48 hours , and abciximab at the time of percutaneous coronary intervention . The use of clopidogrel and intensive lipid-lowering therapy was recommended . The primary end point was a composite of death , nonfatal myocardial infa rct ion , or rehospitalization for anginal symptoms within one year after r and omization . RESULTS The estimated cumulative rate of the primary end point was 22.7 percent in the group assigned to early invasive management and 21.2 percent in the group assigned to selectively invasive management ( relative risk , 1.07 ; 95 percent confidence interval , 0.87 to 1.33 ; P=0.33 ) . The mortality rate was the same in the two groups ( 2.5 percent ) . Myocardial infa rct ion was significantly more frequent in the group assigned to early invasive management ( 15.0 percent vs. 10.0 percent , P=0.005 ) , but rehospitalization was less frequent in that group ( 7.4 percent vs. 10.9 percent , P=0.04 ) . CONCLUSIONS We could not demonstrate that , given optimized medical therapy , an early invasive strategy was superior to a selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level
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 .