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

Background Lipid-lowering agents are known to reduce longterm 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% Cl 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.