Association of Statin Therapy with Outcomes of Acute Coronary Syndromes: The GRACE Study

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.