Early statin therapy in acute myocardial infarction

Objectives: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). Design: A retrospective cohort study was carried out. Setting: National (Spain). Patients or participants: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. Interventions: None. Main variables: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. Results: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P < .001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%Cl 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%Cl 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%Cl 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. Conclusions: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality. (C) 2012 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.