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Post-MI Statin Use Halves Mortality Risk

Administration of statins within 24 hours after heart attack reduces in-hospital death risk more than 50%, according to a large, multi-centre study.

Researchers at UCLA and other medical centers reviewed hospital records of over 170,000 patients with acute myocardial infarction (MI). Their results are published in the 1 September issue of The American Journal of Cardiology and reported in MedPage Today on 30 August 2005.

Data analysis showed that patients who used statins shortly after hospitalization for MI had a lower mortality risk, as well as a lower rate of associated complications (excluding recurrent heart attacks).

“This analysis provides the strongest clinical evidence to date to support the hypothesis of early, direct cardioprotective effects of statins in AMI,” wrote lead author Gregg C. Fonarow, MD, and colleagues. “However, adequately powered prospective randomized clinical trials are needed to confirm these findings before it can be concluded that there are direct cardioprotective effects of statins in AMI.”

Study Protocol

The study examined whether statin use benefits hospital outcomes of patients who experienced acute MI.

Researchers retrospectively examined data from the National Myocardial Infarction Registry 4 database *, which contains information about patients who experienced acute MI at 1,230 United States hospitals.

The data examined included medical records from:

  • 17,118 patients who took statins before hospitalization for acute MI
  • 21,978 patients who took statins within 24 hours of arriving at the hospital
  • 126,128 patients who did not take statins
  • 9,411 patients who had discontinued statin therapy.
Conclusions

Researchers found that a lower mortality risk was associated with statin use within the first 24 hours.

"New or continued treatment with a statin in the first 24 hours was associated with a decreased risk of mortality compared with no statin use (4.0% and 5.3% compared with 15.4% no statin)," the authors wrote.

Also, patients who had discontinued their statin use treatment had a marginally higher mortality risk, compared with patients who took no statins (16.5% versus 15.4%).

Lower associated medical risks were also associated with early statin use and included lower risk of cardiogenic shock, ventricular tachycardia and fibrillation, rupture and cardiac arrest, but not recurrence of MI.

"We were surprised that early statin therapy showed such a striking effect immediately after a heart attack," said Dr. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, according to MedPage Today. "We also found that statins provided additional protection from other heart attack complications as well."

*The National Myocardial Infarction Registry 4 or “NRMI 4” database is funded by Genentech, Inc., who manufactures Activase, a thrombolytic agent.

Sources:

Posted: September 2005


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