title: Very early initiation of statin therapy and mortality in patients with acute coronary syndrome.
abstract: BACKGROUND
  Current guidelines for the treatment of patients with acute coronary syndrome (ACS) recommend the use of statins before hospital discharge. However, the prognostic impact of an early initiation of treatment is uncertain.
  
  
  METHODS
  We reviewed data from randomized controlled trials (RCTs) to test the hypothesis that differences in the time of initiation of statin therapy may be associated with differences in mortality after hospitalization for ACS. We extracted data from 10 RCTs which evaluated one-month mortality of patients early treated with statins (mean time of administration≤72 h from hospitalization) compared to patients receiving placebo or standard care.
  
  
  RESULTS
  Overall, 4030 patients were randomized to statin therapy and 4022 patients to the control group. The effect of statins on mortality was not significant (OR 0.81, 95% CI: 0.58-1.12; P=0.198). The 10 trials were divided up by the mean time of initiation of statin therapy (day 1, day 2 and day 3). Statins reduced mortality when treatment was initiated in day 1 (OR 0.63, 95% CI: 0.41-0.99; P=0.045), not in day 2 or day 3. There was no statistically significant interaction across the subgroups in the risk of mortality (P=0.303).
  
  
  CONCLUSIONS
  In patients admitted to hospital for ACS, statins may reduce hospital mortality when treatment is initiated on the first day of hospitalization.
authors.affiliation: Section of Cardiology, Hospital Media Valle del Tevere, AUSL 2 Umbria, and Department of Internal Medicine, University of Perugia, Perugia Italy. fangeli@cardionet.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Marta
authors.initials: M
authors.lastname: Garofoli
authors.forename: Elisa
authors.initials: E
authors.lastname: Ramundo
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality*; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors