内科学年鉴The Effect of Early, Intensive Statin Therapy.pdfVIP

REVIEW ARTICLE The Effect of Early, Intensive Statin Therapy on Acute Coronary Syndrome A Meta-analysis of Randomized Controlled Trials Eddie Hulten, MD, MPH; Jeffrey L. Jackson, MD, MPH; Kevin Douglas, MD, MPH; Susan George, MD; Todd C. Villines, MD Background: In addition to well-established second- stracted study quality, characteristics, and outcomes. ary prevention benefits for atherosclerotic coronary artery disease, 3-hydroxy-3-methylglutaryl coenzyme Data Synthesis: Thirteen randomized controlled trials A (HMG-CoA) reductase inhibitors (statins) are published before May 2006 were available, involving hypothesized to have short-term benefit in acute coro- 17 963 adults (median number of patients, 135; median nary syndrome (ACS), yet the data are inconsistent, with follow-up, 6 months). Early, intensive statin therapy for some trials underpowered to demonstrate therapeutic ACS decreased the rate of death and cardiovascular events benefit. Our objective was to determine the effects of over 2 years of follow-up (hazard ratio, 0.81 [95% con- early, intensive statin therapy for ACS. fidence interval, 0.77-0.87]) (Q 2 3 =58.54; P.001; I =95%). Survival curves revealed that this benefit begins to oc- Data Sources: Studies found in the PubMed, MEDLINE, cur between 4 and 12 months, achieving statistical sig- EMBASE, BIOSIS, SciSearch, PASCAL, and Interna- nificance by 12 months. There was no evidence of pub- tional Pharmaceutical Abstracts (IPA) databases and the lication bias, and sensitivity analyses did not ident