Key result
Atorvastatin 80 mg daily reduced the composite of death, non-fatal myocardial infarction, resuscitated sudden cardiac death, or emergent rehospitalization by 2.6% absolute (RR 0.84) compared to placebo at 16 weeks.
Why the study?
Does atorvastatin 80 mg once daily reduce the composite of death, non-fatal myocardial infarction, resuscitated sudden cardiac death, or emergent rehospitalization for recurrent ischemia in patients with recent unstable angina or non-Q-wave myocardial infarction?
RCT (n=3,086)
Placebo-controlled
Randomized
Does atorvastatin 80 mg once daily reduce the composite of death, non-fatal myocardial infarction, resuscitated sudden cardiac death, or emergent rehospitalization for recurrent ischemia in patients with recent unstable angina or non-Q-wave myocardial infarction?
Early initiation of high-dose atorvastatin after an acute coronary syndrome is safe and reduces recurrent ischemic events at 16 weeks, supporting inpatient initiation of statin therapy.
The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study was the first trial to assess whether statins might be of clinical benefit in those with recently unstable coronary disease. MIRACL found that high-dose atorvastatin was safe and reduced the incidence of the composite endpoint, death, non-fatal myocardial infarction, resuscitated sudden cardiac death or emergent rehospitalization for recurrent ischemia at 16 weeks when compared with placebo. Despite a number of important study limitations, MIRACL's findings and the prior observation that inpatient initiation of lipid-lowering therapy is associated with higher rates of subsequent utilization, suggest that it is prudent to begin statin therapy when patients present with an acute coronary syndrome.
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Herbert D. Aronow (2002) conducted an RCT in Unstable angina or non-Q-wave myocardial infarction (n=3,086). Atorvastatin vs. Placebo was evaluated on Composite of death, non-fatal myocardial infarction, resuscitated sudden cardiac death or emergent rehospitalization for worsening symptomatic myocardial ischemia (RR 0.84, 95% CI 0.70-1.00, p=0.048). Atorvastatin 80 mg daily reduced the composite of death, non-fatal myocardial infarction, resuscitated sudden cardiac death, or emergent rehospitalization by 2.6% absolute (RR 0.84) compared to placebo at 16 weeks.
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