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Prescribing Statins for Patients With ACS? No Need to Wait

The best time to start a statin in patients with acute coronary syndrome is before they undergo percutaneous coronary intervention.

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PRACTICE CHANGER
Prescribe a high-dose statin before any patient with acute coronary syndrome (ACS) undergoes percutaneous coronary intervention (PCI); it may be reasonable to extend this to patients being evaluated for ACS.1

STRENGTH OF RECOMMENDATION
A: Based on a meta-analysis1

ILLUSTRATIVE CASE
A 48-year-old man comes to the emergency department with chest pain and is diagnosed with ACS. He is scheduled to have PCI within the next 24 hours. When should you start him on a statin?

Statins are the mainstay pharmaceutical treatment for hyperlipidemia and are used for primary and secondary prevention of coronary artery disease and stroke.2,3 Well known for their cholesterol-lowering effect, they also offer benefits independent of lipids, including improving endothelial function, decreasing oxidative stress, and decreasing vascular inflammation.4-6

Compared to patients with stable angina, those with ACS experience markedly higher rates of coronary events, especially immediately before and after PCI and during the subsequent 30 days.1 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of non-ST elevation myocardial infarction (NSTEMI) advocate starting statins before patients are discharged from the hospital, but they don’t specify precisely when.7

Considering the higher risk for coronary events before and after PCI and statins’ pleiotropic effects, it is reasonable to investigate the optimal time to start statins in patients with ACS.

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