- Question
- Does starting atorvastatin early after an acute coronary syndrome reduce death and nonfatal ischemic events during the early, highest-risk period?
- Design
- Randomized, double-blind, placebo-controlled trial conducted from May 1997 to September 1999 at 122 centers in Europe, North America, South Africa and Australasia, enrolling 3086 patients with 16 weeks of follow-up.
- Population
- Adults aged 18 years or older with unstable angina or non-Q-wave myocardial infarction, enrolled 24 to 96 hours after hospital admission.
- Intervention
- Atorvastatin 80 mg daily, started 24 to 96 hours after admission.
- Control
- Matching placebo, started on the same schedule.
- Primary outcome
- Composite of death, nonfatal acute myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence requiring emergency rehospitalization.
- Results
- A primary end point event occurred in 228 patients (14.8%) with atorvastatin and 269 (17.4%) with placebo (RR 0.84; 95% CI 0.70-1.00; P = .048). The difference was driven by symptomatic ischemia requiring rehospitalization (6.2% vs 8.4%; RR 0.74; 95% CI 0.57-0.95; P = .02), with no significant differences in death, nonfatal myocardial infarction or cardiac arrest.
- Safety
- Abnormal liver transaminases (more than 3 times the upper limit of normal) were more common with atorvastatin (2.5% vs 0.6%; P < .001). There were fewer strokes with atorvastatin (12 vs 24 events; P = .045).
- Conclusion
- In patients with acute coronary syndrome, atorvastatin 80 mg/d reduced recurrent ischemic events over the first 16 weeks, mainly recurrent symptomatic ischemia requiring rehospitalization.
- Why it matters
- It supported starting a high-dose statin early during hospitalization for acute coronary syndrome rather than delaying it, shifting practice toward intensive lipid-lowering therapy from the time of admission.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026