Introduction: Pharmacological treatment options for acute coronary syndrome (ACS) are well established, but little is known about the optimal timing of administration of each individual drug, particularly within the first 24 hours. (1-4) The aim of the study was to gather data on early outcomes of ACS through the local ACS registry (part of the International Registry of Acute Coronary Syndromes in Transitional Countries (ISACS-TC).

Patients and Methods: We conducted a retrospective observational single center study in the period from January 2013 to January 2015. Study population included 1197 ACS patients (pts) (563 pts with acute ST segment elevation myocardial infarction, 630 pts with non-ST segment elevation myocardial infarction + pts with unstable angina, 4 pts missing; 372 females, 825 males, 66±11 years). Overall, median hospital length of stay was 5 days (3-8). Multiple binary logistic regression with in-hospital death as primary outcome was used for statistical analysis. For group comparison Pearson chi square, Student’s t-test and Mann Whitney tests were used.

Results: In the first 24 hours following ACS, statins were administered in 94%, beta-blockers (BB) in 87%, and ACE inhibitors (ACEI) in 89% of pts. Among the early treatment positive and negative groups, pts did not differ according to age, gender, presence of diabetes, left ventricular ejection fraction (LVEF), body mass index, smoking status, creatine kinase levels and the history of heart failure for each of the studied groups. The odds ratio [OR] for in-hospital death was significantly lower in the early statin group (1104 pts, OR 0.019, 95% confidence interval [CI] 0.002-0.224, p = 0.002). Older age, higher creatinine level and lower LVEF were positively associated with increased odds for primary outcome in regression model. As opposed to early statin treatment, early administration of BB and ACEI did not reduce in-hospital mortality (p=0.06, p=0.27) at a significance level of 0.05. The crude overall primary outcome rate was 4%. In pts without statins treatment within the first 24h the mortality rate was 22% (p<0.001), and only 5% in pts without BB or ACEI (Figure 1).

Conclusion: Initiation of statin therapy within the first 24h following ACS significantly reduces in-hospital mortality.