SUMMARIES FOR PATIENTS

Statin Therapy and the Outcomes during Hospitalization for Acute Coronary Syndromes

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The summary below is from the full report titled "Association of Statin Therapy with Outcomes of Acute Coronary Syndromes: The GRACE Study." It is in the 1 June 2004 issue of Annals of Internal Medicine (volume 140, pages 857-866). The authors are F.A. Spencer, J. Allegrone, R.J. Goldberg, J.M. Gore, K.A.A. Fox, C.B. Granger, R.H. Mehta, and D. Brieger, for the GRACE Investigators.

What is the problem and what is known about it so far?

Acute coronary syndromes involve blockages in blood flow to heart muscle. If the blockage lasts long enough, an area of heart muscle dies, a condition commonly known as a heart attack or myocardial infarction. The goal of treatment for acute coronary syndromes is to keep heart muscle alive and prevent bad outcomes such as heart attack or death. Statins are medications that are often used to treat high cholesterol levels. Many studies show that statins are effective in preventing future heart attacks and angina. Some experts think that statins may also be helpful as a treatment during acute coronary syndromes. However, no studies directly answer the question of whether statin treatment during acute coronary syndromes improves patient outcomes.

Why did the researchers do this particular study?

To determine whether patients who took statins during hospitalizations for acute coronary syndromes did better than patients who did not.

Who was studied?

19,537 patients hospitalized for an acute coronary syndrome from April 1999 to September 2002. All of the patients were participating in a study of acute coronary syndromes that involved 94 hospitals in 14 countries.

How was the study done?

The researchers determined whether patients were taking statins when they presented to the hospital and whether they took statins during the hospitalization. The researchers compared the frequency of heart attack, complications such as stroke, and death during hospitalization in the following groups of patients: 1) patients who presented to the hospital while taking statins and kept taking them, 2) patients who presented while taking statins but stopped taking them during the hospitalization, 3) patients who were not taking statins but started taking them during the hospitalization, 4) and patients who were not taking statins and did not start taking them during the hospitalization.

What did the researchers find?

Compared with patients who never received statins, patients who presented to the hospital while taking statins and continued to take them were less likely to suffer complications, heart attack, or death. In addition, patients who started taking statins only after hospitali-zation were less likely to die during hospitalization than patients who never received statins. However, the association of good outcomes with statins became less striking when the researchers did analyses that accounted for the hospital where a patient received care.

What were the limitations of the study?

Although these observations suggest a potential benefit of statins during acute coronary syndromes, the results may be due to the fact that patients who received statins were less sick than patients who did not. It is also possible that hospitals that used statins frequently were different in other ways than hospitals that used them less frequently. Only a randomized, controlled trial, a study that would assign patients at random to receive statins or not during acute coronary syndromes, can prove the benefits of statins in acute coronary syndromes.

What are the implications of the study?

This study suggests that a randomized, controlled trial of statins in acute coronary syndromes would be justified.