Updated evidence on early statin therapy for acute coronary syndromes: Meta-analysis of 18 randomized trials involving over 14,000 patients

Abstract: Background: The short-term effects of early statin therapy in acute coronary syndromes (ACS) on clinical outcomes remain unclear. Our objective was to update the evidence on patient relevant outcomes from all randomized trials comparing early statin therapy with placebo or usual care at 1 and 4months following ACS. Methods: We performed a systematic review and meta-analysis of randomized trials that compared statins to control, initiated within 14days after onset of ACS and with minimal follow-up of 30days. Data were extracted in duplicate and analyzed by a random effects model. Investigators from individual trials contributed additional data where needed. Results: A total of 18 trials involving 14,303 patients with ACS were included in the meta-analysis. We found no evidence for further trials on the topic. Risk ratios for the combined endpoint of death, myocardial infarction, and stroke of early statin therapy compared to control were 0.93 (95% confidence interval [CI], 0.80–1.08; P =0.34) at 1month and 0.93 (95% CI, 0.81–1.06; P =0.27) at 4months following ACS. There were favorable trends related to statin use for all individual secondary endpoints but there was no statistically significant risk reduction except for unstable angina with a risk ratio of 0.76 (95% CI, 0.59–0.96; P =0.02) at 4months following ACS. Conclusions: Initiation of statin therapy within 14days following ACS results in directionally favorable but non-significant reduction in death, myocardial infarction, or stroke up to 4months, and significant reduction in the occurrence of unstable angina at 4months following ACS. [Copyright &y& Elsevier]