Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: An observational study

Background: Lipid-lowering agents are known to reduce long-term mortality in patients with stable coronary disease or significant risk factors. However, the effect of lipid-lowering therapy on short-term mortality immediately after an acute coronary syndrome has not been determined. We did an observational study using data from two randomised trials to investigate this issue. Methods: We used data from the GUSTO IIb and PURSUIT trials to compare all-cause mortality among patients with acute coronary syndromes who were discharged on lipid-lowering agents (n=3653) with those who were not (n=17 156). A propensity analysis was done to adjust for presumed selection biases in the prescription of lipid-lowering agents. Findings: Lipid-lowering therapy was associated with a smaller proportion of deaths at 30 days (17 [0·5%] vs 179 [1·0%], hazard ratio 0·44 [95% CI 0·27-0·73], p=0·001) and at 6 months (63 [1·7%] vs 605 [3·5%], 0·48 [0·37-0·63], p<0·0001). After adjustment for the propensity to be prescribed lipid-lowering agents and other potential confounders, prescription of a lipid-lowering agent at discharge remained associated with a reduced risk of death at 6 months (0·67 [0·48-0·95], p=0·023). Interpretation: Prescription of a lipid-lowering drug at hospital discharge was independently associated with reduced short-term mortality among patients after an acute coronary syndrome.