Statins Given Within 24 Hours of Acute Myocardial Infarction Halves Early Mortal

Statins given within 24 hours of acute myocardial infarction (AMI) reduce complications and mortality.

"We’ve known that long-term statin therapy is beneficial, but this study provides the strongest clinical evidence to date supporting the early cardioprotective effects of statins immediately following a heart attack," lead author Gregg C. Fonarow, MD, from the University of California–Los Angeles, says in a news release. "As statins are already routinely started in myocardial infarction patients prior to hospital discharge, it would be relatively easy to administer this medication on arrival to the emergency department."

Using data from 300,823 patients with AMI enrolled in the National Registry of Myocardial Infarction 4, the investigators compared in-hospital events between patients who continued statin therapy received before the index AMI hospitalization (n = 17,118) or newly started statin therapy within the first 24 hours of hospitalization (n = 21,978) and patients not receiving early statin treatment (n = 126,128) or who discontinued statin therapy (n = 9,411).

Compared with no statin use, new or continued statin treatment in the first 24 hours was associated with decreased risk of mortality (4.0% and 5.3% vs 15.4%, respectively). Discontinuing statin treatment was associated with a slightly higher risk of mortality (16.5%).

Early use of a statin was also associated with lower risks of cardiogenic shock, arrhythmias, cardiac arrest, and rupture, but not of recurrent myocardial infarction. Based on propensity analysis, mortality odds ratios were 0.46 for continued therapy, 0.42 for newly started therapy, and 1.25 for discontinued therapy for matched pairs vs no statin therapy (P < .0001 for all comparisons).
"The use of statin therapy within the first 24 hours of hospitalization for AMI is associated with a significantly lower rate of early complications and in-hospital mortality," the authors write. "Potential mechanisms of early benefit in AMI with statins include decreases in inflammatory cell accumulation in the ischemic myocardium, oxidative stress, and monocyte adhesion…. 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."
Am J Cardiol. 2005;96:611-616

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