[Statins and unstable angina: MIRACL].
Statins have demonstrated their aptitude to lower hypercholesterolemia, and to prevent the occurrence of arterial, coronary, and cerebral events, by primary and secondary prevention in patients with low or high risk to develop coronary artery disease. In the first time, with MIRACL and Atrovastatine, statins are proposed in the therapeuty of unstable angina. This study was successful. In fact, in this comparative study, high dose of Atrovastatine (80 mg/day) administrated in the acute phase of non Q-wave myocardial infarction or unstable angina, reduce ischemic events (RR=0.84, p=0.048 ). After anticoagulants and a wide group of platelets antiagregants, this statin brings a new agent to the chemotherapy of the atherosclerotic unstable lesion. The TACTICS-TIMI 18 and the sub-group of the FRISC II study, demonstrate the necessity to stratify the unstable angina risk by electric and biologic arguments. They confirm the efficacy of invasive strategy, with coronarography, and immediate revascularisation, in patients with high risk with persistent modifications of ST segment, and increasing Troponins level. Under the cover of a large medical treatment composed of anti-ischemic, Aspirine, LMWH, and now a high dose of statins, the acute coronary syndrome invasive attitude must be guided by electric, biologic and the invasive attitude prognostic risk.
Service de Cardiologie B, CHU Rangueil, 1, avenue Jean Pouilhès, 31403 Toulouse Cedex. puel.jacques@chu-toulouse.fr
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D000789:Angina, Unstable / Q000188:drug therapy*; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D002784:Cholesterol / Q000097:blood; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011758:Pyrroles / Q000627:therapeutic use*
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D002784:Cholesterol; D000069059:Atorvastatin