Effect of early versus late in-hospital initiation of statin therapy on the clinical outcomes of patients with acute coronary syndrome.

Statins provide effective secondary prevention of cardiovascular events after acute coronary syndrome (ACS). Current guidelines recommend that statins be initiated in ACS patients before hospital discharge. In this retrospective study, we investigated the influence of early compared with late in-hospital initiation of statin therapy on the clinical outcomes of ACS patients. Two hundred and ten ACS patients who had no history of statin treatment before hospitalization were enrolled. The patients were divided into early (statin treatment initiated < or = 2 days after admission) and late (statin treatment initiated > 2 days after admission and before discharge) statin groups. We examined the association between early statin use and clinical outcomes in these patients using Cox proportional hazards models. Four months after discharge, event-free survival was 85% in the early statin group and 79% in the late statin group. In multivariate analyses, Killip IV classification and abnormal renal function were independent predictors of the composite endpoint of cardiovascular death, recurrent myocardial infarction, angina requiring rehospitalization, revascularization, and stroke. Early statin treatment had no significant influence (hazard ratio: 1.11; 95% confidence interval: 0.54 to 2.25; P = 0.78) on the composite endpoint 4 months after discharge. At 12 months after discharge, early statin treatment still had no significant influence on the composite endpoint (hazard ratio: 1.53; 95% confidence interval: 0.83 to 2.81; P = 0.17). We concluded that ensuring all eligible ACS patients begin statin therapy during their hospital stay is more important than emphasizing immediate statin use after admission.