Document Detail


Early withdrawal of statin therapy in patients with non-ST-segment elevation myocardial infarction: national registry of myocardial infarction.
MedLine Citation:
PMID:  15505131     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is increasing interest in the non-lipid-lowering effects of statins and their effect on outcomes in patients with acute coronary syndrome. It has been suggested that withdrawal of statin therapy during an acute coronary syndrome may attenuate any benefits of pretreatment, thereby providing indirect evidence of the importance of their non-lipid-lowering effects. METHODS: This observational study compared the demographic and clinical characteristics and hospital outcomes in patients with non-ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction 4. Comparison groups consisted of patients previously receiving statins who also received statins within 24 hours of hospital admission (n = 9,001), patients previously using statins in whom therapy was discontinued (n = 4,870), and patients who did not receive statins at any time before or during hospitalization (n = 54,635). RESULTS: Of 13,871 patients receiving statins before hospital admission, 35.1% had treatment withdrawn during the first 24 hours of hospitalization. These patients had increased hospital morbidity and mortality rates relative to patients in whom therapy was continued, with higher rates of heart failure, ventricular arrhythmias, shock, and death. In multivariate analyses, these patients were at statistically significant increased risk of hospital death compared with those continuing statin therapy and at similar risk compared with those not receiving statins before or during hospitalization. CONCLUSIONS: Withdrawal of statin therapy in the first 24 hours of hospitalization for non-ST-segment elevation myocardial infarction is associated with worse hospital outcomes. In the absence of data from randomized clinical trials, our findings suggest that statin therapy should be continued during hospitalization for myocardial infarction unless strongly contraindicated.
Authors:
Frederick A Spencer; Gregg C Fonarow; Paul D Frederick; R Scott Wright; Nathan Every; Robert J Goldberg; Joel M Gore; Wei Dong; Richard C Becker; William French;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  164     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-26     Completed Date:  2005-04-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2162-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. spencerf@ummhc.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Cross-Sectional Studies
Electrocardiography
Female
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*,  therapeutic use
Male
Middle Aged
Myocardial Infarction / drug therapy*,  epidemiology
Registries*
Time Factors
Treatment Outcome
United States / epidemiology
Withholding Treatment
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors

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


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