Statin對冠狀動脈疾病患者的好處已在次級預防研究中被證實，然而，這些研究只納入病情穩定的患者（過去至少3個月內不得有急性心肌梗塞或不穩定心絞痛發生），急性冠心症發生後及早投予Statin的角色仍不明確。本回溯性觀察研究目的為評估是否在急性冠心症發作兩天之內投予Statin對病人預後較佳。
本研究納入自民國89年至93年，曾經因為第一次急性冠心症發作住進台南市國立成功大學醫學院附設醫院，並且在出院前有接受Statin治療的病人。排除標準為：病人住院前一個月內曾經使用Statin，或是住院時使用Statin未滿7天，在一年當中失去追蹤的病人也予以排除。一共納入了210位研究病患，依照住院後開始投予Statin之天數分為兩組：早給組（2天內投予Statin，N=98），晚給組（超過2天才投予Statin，N=102）。評估病人出院後一年的無事件生存率（event-free survival），終點指標為：所有原因死亡、心血管事件死亡、非致死性心肌梗塞、胸痛發作送到急診室、中風、血管重建手術、心血管事件住院。
結果顯示在早給組和晚給組的住院中、4個月、12個月的心血管事件死亡率和所有原因死亡率沒有統計差異，其他終點指標方面也同樣不具統計意義。以Cox proportional hazard regression校正基礎共變項後，只有慢性腎衰竭會增加12個月的心血管事件死亡率危險性5.95倍（p=0.03）；而影響12個月心血管事件住院率的獨立影響因子有：Killip Ⅳ會增加住院危險性3.32倍（p=0.013）、抽煙增加危險性2.86倍（p=0.004）、慢性腎衰竭增加危險性3.32倍（p<0.001）。
本研究中及早給予Statin相較於較晚才給的病人，心血管事件死亡率以及其他個別臨床預後並沒有統計差異 。另外，觀察本研究所投予的Statin起始劑量，和國外證實及早投予Statin會減少終點指標發生的隨機對照試驗相比，劑量明顯少很多。

Background / Aims: Statins have been shown to benefit patient with coronary artery disease (CAD) in secondary prevention studies. However, only patients with stable CAD [>3-6 months since last acute myocardial infarction (MI) or episode or unstable angina] were included in previous studies. The role of earlier initiation of statins after acute coronary syndrome (ACS) is unknown. We conducted a retrospective observational study to see if there is any association of early initiation of statin therapy (≦ 2 days) after ACS with better clinical outcome.
Method: Patients admitted to our hospital from 2000-2004 for their first attack of ACS and received statin before discharge were recruited in this study. Exclusion criteria were patients who used or had used statin within 1 months before admission, the duration of statin therapy < 7 day, and patients who lost follow-up during one year. The 210 eligible subjects were divided into early group (received statins within 2 days of admission, N=98) and late group (treated with statins > 2 days of admission, N=112). We evaluated the event-free survival in these patients during one year after discharge. The endpoints were cardiovascular (CV) mortality, nonfatal MI, emergency room (ER) visit due to chest pain, stroke, revascularization, hospitalization due to CV event, and all-cause mortality.
Results: There were no significant differences in in-hospital, 4-months and 12-months CV or all-cause mortality between early statin group and late statin group. There were also no differences in other endpoints. Parameters included in the Cox proportional hazard regression model that independently associated with CV mortality in 12 months was chronic renal failure (CRF) (RR, 5.95, p=0.030). Parameters that independently associated with 12 months hospitalization were Killip Ⅳ(RR, 3.32, p=0.013), smoking (RR, 2.86, p=0.004) and CRF (RR, 3.32, p<0.001).
Conclusions: In this study, there was no statistically significant risk reductions from early statin therapy for CV-cause death and other clinical outcomes. The immediacy of the statin effects within 2 days and their translation to clinical outcome has not been proved in our study. The dose of statins in this study were much smaller than that used in other randomized controlled trials which have suggested early statin therapy may reduce composite endpoints in ACS patients.

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