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ARTICLE

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

Frederick A. Spencer, MD; Jeanna Allegrone, BA; Robert J. Goldberg, PhD; Joel M. Gore, MD; Keith A.A. Fox, MB, ChB, FRCP; Christopher B. Granger, MD; Rajendra H. Mehta, MD; David Brieger, MD, the GRACE Investigators*

1 June 2004 | Volume 140 Issue 11 | Pages 857-866

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.

*For a list of the members of the GRACE Scientific Advisory Committee, see the Appendix.

Editors' Notes Context While the benefits of statins in the primary and secondary prevention of coronary artery disease are clear, the value of statin therapy in acute coronary syndromes is uncertain. Contribution Analyzing data from a large, international observational study of acute coronary syndromes, these investigators identified associations between statin use before and during acute coronary events and favorable outcomes. Cautions While these data suggest a potential benefit of statins during acute coronary events, trials are necessary to determine the most appropriate use of statins in the treatment of acute coronary events. –The Editors

 

Author and Article Information

From University of Massachusetts Medical School, Worcester, Massachusetts; The University and The Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Duke University Medical Center, Durham, North Carolina; University of Michigan, Ann Arbor, Michigan; and Concord Hospital, Sydney, Australia.

Grant Support: GRACE is supported by an unrestricted educational grant from Aventis Pharma, Bridgewater, New Jersey.

Potential Financial Conflicts of Interest:Honoraria: K.A.A. Fox (Aventis, Bristol-Myers Squibb/Sanofi); Grants received: K.A.A. Fox (Aventis, Bristol-Myers Squibb/Sanofi), C.B. Granger (Aventis, Bristol-Myers Squibb/Sanofi, Organon, Novartis, AstraZeneca).

Requests for Single Reprints: Frederick A. Spencer, MD, Department of Medicine/Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655; e-mail, spencerf{at}ummhc.org.

Current Author Addresses: Drs. Spencer, Goldberg, and Gore and Ms. Allegrone: Department of Medicine/Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Fox: The Royal Infirmary of Edinburgh, Department of Cardiology, Edinburgh, Scotland EH3 9WY, United Kingdom.

Dr. Granger: Duke University Medical Center, 2400 Pratt Street, Room 0311, Terrace Level, Box 3409, Durham, NC 27705.

Dr. Mehta: University of Michigan Health System, Division of Cardiology, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0366.

Dr. Brieger: Concord Repatriation Hospital, Coronary Care Unit, Level 3, Multi Building, Hospital Road, Concord NSW 2139, Australia.

Author Contributions: Conception and design: F.A. Spencer, J.M. Gore, C.B. Granger.

Analysis and interpretation of the data: F.A. Spencer, J. Allegrone, R.J. Goldberg, J.M. Gore, K.A.A. Fox.

Drafting of the article: F.A. Spencer, R.J. Goldberg.

Critical revision of the article for important intellectual content: F.A. Spencer, R.J. Goldberg, J.M. Gore, K.A.A. Fox, C.B. Granger, R.H. Mehta, D. Brieger.

Final approval of the article: F.A. Spencer, J. Allegrone, R.J. Goldberg, J.M. Gore, K.A.A. Fox, C.B. Granger, R.H. Mehta, D. Brieger.

Provision of study materials or patients: R.H. Mehta, D. Brieger.

Statistical expertise: J. Allegrone.

Obtaining of funding: J.M. Gore.

Administrative, technical, or logistic support: J.M. Gore.

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