Very early initiation of statin therapy and mortality in patients with acute coronary syndrome.

Background: Current guidelines for the treatment of patients with acute coronary syndrome (ACS) recommend the use of statins before hospital discharge. However, the prognostic impact of an early initiation of treatment is uncertain. Methods: We reviewed data from randomized controlled trials (RCTs) to test the hypothesis that differences in the time of initiation of statin therapy may be associated with differences in mortality after hospitalization for ACS. We extracted data from 10 RCTs which evaluated one-month mortality of patients early treated with statins (mean time of administration ≤ 72 h from hospitalization) compared to patients receiving placebo or standard care. Results: Overall, 4030 patients were randomized to statin therapy and 4022 patients to the control group. The effect of statins on mortality was not significant (OR 0.81, 95\% CI: 0.58-1.12; P = 0.198). The 10 trials were divided up by the mean time of initiation of statin therapy (day 1, day 2 and day 3). Statins reduced mortality when treatment was initiated in day 1 (OR 0.63, 95\% CI: 0.41-0.99; P = 0.045), not in day 2 or day 3. There was no statistically significant interaction across the subgroups in the risk of mortality (P = 0.303). Conclusions: In patients admitted to hospital for ACS, statins may reduce hospital mortality when treatment is initiated on the first day of hospitalization.