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Odkazy a zdroje - Studie - MIRACL


Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering

(a) Schwartz GG, Oliver MF, Ezekowitz MD, Ganz P, Waters D, Kane JP, Texter M, Pressler ML, Black D, Chaitman B, Olsson AG
(b) Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR, Leslie S, Stern T
(c) Waters DD, Schwartz GG, Olsson AG, Zeiher A, Oliver MF, Ganz P, Ezekowitz M, Chaitman BR, Leslie SJ, Stern T

(a) Rationale and design of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study that evaluates atorvastatin in unstable angina pectoris and in non-Q-wave acute myocardial infarction
(b) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes
(c) Effects of atorvastatin on stroke in patients with unstable angina or non-Q-wave myocardial infarction

(a) Am J Cardiol 1998;81:578–81
(b) JAMA 2001;285:1711–8
(c) Circulation 2002;106:1690–5

Non-Q-wave MI, unstable angina pectoris

To determine whether early, rapid and profound cholesterol-lowering therapy with atorvastatin reduces early recurrent ischaemic events in patients with unstable angina or non-Q-wave MI

Study design
Randomised, double-blind, placebo-controlled

16 weeks

3086 patients, (1538 atorvastatin, 1548 placebo), aged 65 ± 12 years, with documented myocardial ischaemia or MI within the previous 1–4 days

Treatment regimen
Atorvastatin, 80 mg once daily, or placebo

Concomitant therapy
Dietary counselling

A primary endpoint of death, nonfatal MI, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischaemia with objective evidence and requiring emergency rehospitalisation occurred in 14.8% of patients in the atorvastatin group and 17.4% in the placebo group (p = 0.048). Compared to placebo, atorvastatin reduced the risk of ischaemia with objective evidence and requiring emergency hospitalisation (6.2% vs 8.4%; p = 0.02), but did not reduce the risk of death, nonfatal MI, or cardiac arrest. Fatal or nonfatal stroke occurred in 12 atorvastatin patients and 24 placebo patients (relative risk 0.49; p = 0.04)