Document Detail


Association of statin therapy with outcomes of acute coronary syndromes: the GRACE study.
MedLine Citation:
PMID:  15172899     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Statins administered early in patients with acute coronary syndromes may lead to modest reductions in recurrent ischemic events. OBJECTIVE: To examine the association between previous and early in-hospital statin therapy and the presentation and outcomes of an acute coronary syndrome. DESIGN: Cohort study. SETTING: 94 hospitals in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE). PATIENTS: 19,537 patients with an acute coronary syndrome who were enrolled from April 1999 to September 2002. MEASUREMENTS: Statin use before and after presentation with an acute coronary syndrome and associated rates of myocardial infarction, hospital complications, and hospital mortality. The composite end point included death, in-hospital myocardial infarction, and stroke. RESULTS: Patients who were already taking statins when they presented to the hospital were less likely to have ST-segment elevation (odds ratio [OR], 0.79 [95% CI, 0.71 to 0.88]) or myocardial infarction (OR, 0.78 [CI, 0.70 to 0.86]). Patients who continued to take statins in the hospital were less likely to experience complications or die than patients who never received statins (OR, 0.66 [CI, 0.56 to 0.77]). Patients not previously taking statins who began statin therapy in the hospital were less likely to die than patients who never received statin therapy (OR, 0.38 [CI, 0.30 to 0.48]). However, adjustment for the hospital of admission attenuated the association between initiation of statin therapy and the composite end point (OR, 0.84 [CI, 0.65 to 1.10]). LIMITATIONS: This observational study cannot exclude confounding by clinical and hospital factors. CONCLUSIONS: These data support the hypothesis that statin therapy can modulate early pathophysiologic processes in patients with acute coronary syndromes. A randomized trial of statin therapy in acute myocardial infarction is warranted.
Authors:
Frederick A Spencer; Jeanna Allegrone; Robert J Goldberg; Joel M Gore; Keith A A Fox; Christopher B Granger; Rajendra H Mehta; David Brieger;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  140     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-02     Completed Date:  2004-06-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  857-66     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine/Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. spencerf@ummhc.org
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Cohort Studies
Coronary Disease / complications,  drug therapy*,  mortality
Electrocardiography
Female
Hospital Mortality
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Male
Middle Aged
Myocardial Infarction / etiology,  prevention & control
Recurrence / prevention & control
Stroke / etiology,  prevention & control
Syndrome
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections
Comment In:
Ann Intern Med. 2004 Jun 1;140(11):923-4   [PMID:  15172907 ]
Ann Intern Med. 2004 Jun 1;140(11):I29   [PMID:  15172925 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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