MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering)

18 Mar, 14

Introduction

Effect of atorvastatin on early recurrent ischemic events in acute coronary syndromes.

Purpose

To determine whether treatment with atorvastatin 80 mg/day, initiated 24 to 96 hours after an acute coronary syndrome, reduced the occurrence of these early events.

Design

Randomized, double-blind, placebo-controlled study.

Patients

3086 adults with unstable angina or non Q-wave myocardial infarction.

16 weeks. Primary endpoint was defined as death, nonfatal acute myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence and requiring emergency rehospitalisation.

Treatment Regimen

Atorvastatin 80 mg/day vs. placebo

Results

Primary endpoint event occurred in 14.8% in the atorvastatin group compared to 17.4% in the placebo group (RR, 0.84).
There were no significant differences in risk of death, nonfatal myocardial infarction, or cardiac arrest between the atorvastatin group and the placebo group, although the atorvastatin group had a lower risk of symptomatic ischemia with objective evidence and requiring emergency rehospitalisation (6.2% vs 8.4%; RR 0.74).
There were no significant differences in the incidence of secondary outcomes of coronary revascularisation procedures, worsening heart failure, or worsening angina, although there were fewer strokes in the atorvastatin group than in the placebo group (12 vs 24 events).

Conclusion

For patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin 80 mg/day reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalisation.

JAMA 2001;285:1711-8