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Early Withdrawal of Statin Therapy in Patients With Non–ST-Segment Elevation Myocardial Infarction
National Registry of Myocardial Infarction
Frederick A. Spencer, MD;
Gregg C. Fonarow, MD;
Paul D. Frederick, MPH, MBA;
R. Scott Wright, MD;
Nathan Every, MD, MPH;
Robert J. Goldberg, PhD;
Joel M. Gore, MD;
Wei Dong, MD, PhD;
Richard C. Becker, MD;
William French, MD; for the National Registry of Myocardial Infarction Investigators
Arch Intern Med. 2004;164:2162-2168.
Background There is increasing interest in the non–lipid-lowering effects of statins and their effect on outcomes in patients with acute coronary syndrome. It has been suggested that withdrawal of statin therapy during an acute coronary syndrome may attenuate any benefits of pretreatment, thereby providing indirect evidence of the importance of their non–lipid-lowering effects.
Methods This observational study compared the demographic and clinical characteristics and hospital outcomes in patients with non–ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction 4. Comparison groups consisted of patients previously receiving statins who also received statins within 24 hours of hospital admission (n = 9001), patients previously using statins in whom therapy was discontinued (n = 4870), and patients who did not receive statins at any time before or during hospitalization (n = 54 635).
Results Of 13 871 patients receiving statins before hospital admission, 35.1% had treatment withdrawn during the first 24 hours of hospitalization. These patients had increased hospital morbidity and mortality rates relative to patients in whom therapy was continued, with higher rates of heart failure, ventricular arrhythmias, shock, and death. In multivariate analyses, these patients were at statistically significant increased risk of hospital death compared with those continuing statin therapy and at similar risk compared with those not receiving statins before or during hospitalization.
Conclusions Withdrawal of statin therapy in the first 24 hours of hospitalization for non–ST-segment elevation myocardial infarction is associated with worse hospital outcomes. In the absence of data from randomized clinical trials, our findings suggest that statin therapy should be continued during hospitalization for myocardial infarction unless strongly contraindicated.
Author Affiliations: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Spencer, Goldberg, and Gore); Ahmanson–University of California, Los Angeles (UCLA) Cardiomyopathy Center, Division of Cardiology, UCLA, Los Angeles (Dr Fonarow); Ovation Research Group, Seattle, Wash (Dr Fredrick); Department of Medicine, Mayo Clinic, Rochester, Minn (Dr Wright); Department of Medicine, University of Washington, Seattle (Dr Every); Genentech, Inc, South San Francisco, Calif (Dr Dong); Department of Medicine, Duke Medical Center, Durham, NC (Dr Becker); and Department of Medicine, Harbor-UCLA Medical Center, Los Angeles (Dr French). A list of hospitals participating in the NRMI is available from the NRMI Help Desk at nrmihelpdesk{at}lx.statprobe.com.
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