Lipid-Lowering Drug Therapy Initiated During Hospitalization for Acute Myocardial Infarction is Associated with Lower Postdischarge 1-Year Mortality Robert P. Giugliano Brigham and Women's Hospital, Boston, Massachusetts, USA The benefits of lipid-lowering therapy with statin agents have been clearly established among post-myocardial infarction patients, but not among patients for whom initiation of such therapy occurs during hospitalization for acute myocardial infarction. The results of this study demonstrate that there is a clear benefit in terms of lower 1-year mortality associated with initiation of lipid-lowering therapy while the acute myocardial infarction patient is still in the hospital. Dr. Giugliano began by pointing out that decreases in cardiovascular events and mortality on the order of 20% to 40% have been clearly demonstrated with lipid-lowering therapy using statins among post-myocardial infarction patients. However, very few of the large-scale trials on which he based his comment had randomized patients to such therapy within 3 months of acute with ST-segment elevation myocardial infarctions. Unpublished data from the MIRACL trial of statin therapy in patients with non-Q-wave myocardial infarctions showed no decrease in mortality. (Please note: The "MIRACL" trial is a completely different entity from the "MIRACLE" trial involving cardiac resynchronization in patients with heart failure, the results of which have also been presented at this meeting.) Dr. Giugliano pointed out that the present data were derived from 14,124 patients involved in the InTIME-II trial, which compared different recombinant thrombolytic therapies. "We analyzed baseline characteristics, in-hospital complications, and 1-year mortality in patients with acute myocardial infarction who were started on lipid-lowering therapy with a statin while in the hospital and who survived to hospital discharge. It turned out that 34.3% of the total group of patients who survived to hospital discharge were begun on lipid-lowering therapy while in the hospital. We found that the unadjusted 1-year post-discharge mortality was 33% lower among patients receiving in-hospital lipid-lowering therapy (p <<.001). After multivariate adjustment, this therapy was associated with a 20% to 36% lower 1-year post-discharge mortality." Dr. Giugliano concluded by pointing out that these were observational data and that we need data from prospectively randomized controlled clinical trials to provide better support for our clinical decisions. Several such trials are currently underway. Reporter: Andre Weinberger, MD Copyright 2000-2013 by HESCO International, Ltd. All rights reserved.