March 26, 2002Circulation
Withdrawal of Statins Increases Event Rates in Patients With Acute Coronary Syndromes
Key result
Withdrawal of statins after admission for acute coronary syndromes increased the 30-day risk of death and nonfatal MI compared with continuing statins (HR 2.93; 95% CI 1.64-6.27; P=0.005).
Why the study?
Does the withdrawal of statin therapy increase the risk of death and nonfatal myocardial infarction in patients with acute coronary syndromes?
Population
1616 patients from the PRISM study with coronary artery disease and chest pain in the previous 24 hours
Comparison
Discontinuation of statin therapy after… vs Continued statin therapy and no statin therapy
Design
Cohort
Follow-up
30-day
Authors
Discussion
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Implication
Statin withdrawal after ACS admission was associated with higher short-term risk; leaves open whether randomized trials confirm causality.
Key Points
- The study investigates the effects of statin withdrawal on cardiac event rates in patients with acute coronary syndromes.
- Analyzed data from 1616 patients in the PRISM study with coronary artery disease and chest pain in the previous 24 hours.
- Compared cardiac event rates among patients who continued vs. discontinued statin therapy during a 30-day follow-up.
- Evaluated independent predictors of outcomes including troponin T elevation and ST changes.
- Statin therapy reduced 30-day event rates (adjusted HR 0.49, 95% CI 0.21 to 0.86, P=0.004).
- Withdrawal of statins increased cardiac risk significantly (HR 2.93, 95% CI 1.64 to 6.27, P=0.005).
- Statin discontinuation led to a higher event rate during the first week, independent of cholesterol levels.
Study Design
Type
Cohort (n=1,616)
Structured PICO
Does the withdrawal of statin therapy increase the risk of death and nonfatal myocardial infarction in patients with acute coronary syndromes?
P
Population
1,616 patients with coronary artery disease and chest pain in the previous 24 hours, followed for 30 days to assess the impact of statin withdrawal.
E
Exposure
Discontinuation of statin therapy after hospitalization (n=86)
C
Comparator
Continued statin therapy (n=379) and no statin therapy (n=1249)
O
Outcome
Composite of death and nonfatal myocardial infarction during 30-day follow-upcomposite
Main Result
Hazard Ratio: 2.93 (95% CI 1.64–6.27)
p-value: p=0.005
Discontinuation of statin therapy during an acute coronary syndrome significantly increases the risk of death and nonfatal myocardial infarction compared to continuing therapy.
Cite This Study
Heeschen et al. (2002) conducted a cohort in Acute coronary syndromes (n=1,616). Withdrawal of statin therapy vs. Continued statin therapy was evaluated on Death and nonfatal myocardial infarction (HR 2.93, 95% CI 1.64-6.27, p=0.005). Withdrawal of statins after admission for acute coronary syndromes increased the 30-day risk of death and nonfatal MI compared with continuing statins (HR 2.93; 95% CI 1.64-6.27; P=0.005).