Clinical investigationsEffect of pravastatin compared with placebo initiated within 24 hours of onset of acute myocardial infarction or unstable angina: The Pravastatin in Acute Coronary Treatment (PACT) trial☆
Section snippets
Design
The trial was designed as a double-blinded, placebo-controlled, randomized, multicenter study to assess outcomes at 30 days in patients with an acute myocardial infarction (AMI) or unstable angina pectoris (UAP) randomly assigned to either pravastatin or placebo within 24 hours of the onset of chest pain.
Inclusion criteria
Patients were enrolled in the study within 24 hours of the onset of symptoms if they had electrocardiographic changes suggestive of an AMI or UAP. The diagnosis of an AMI was made on the basis
Study population
Three thousand four hundred eight patients were randomly assigned to the treatment arms of the study. The initial diagnosis at the time of random assignment was AMI in 2006 (58.9%) patients and UAP in 1402 (41.1%) patients. When biochemical markers and serial electrocardiographic changes were subsequently evaluated, the confirmed diagnoses were AMI in 2220 patients (65.1%), UAP in 1036 patients (30.3%), and other diagnoses in 152 patients (4.6%). Patients whose diagnosis was other than AMI or
Discussion
As well as lowering serum LDL concentrations, statins have been demonstrated to influence a number of other mechanisms that are potentially important in the treatment of acute coronary syndromes. Animal studies have revealed potential roles for statins in plaque stabilization by increasing collagen content of the unstable plaque12 and reducing macrophage activation and expression of matrix metalloproteinases.13 Reductions in plasma fibrinogen14 and thrombogenic factors have been demonstrated in
References (31)
- et al.
Beneficial effects of pravastatin (+/colestyramine/niacin) initiated immediately after a coronary event (the randomized Lipid-Coronary Artery Disease [L-CAD]Study)
Am J Cardiol
(2000) - et al.
Is vascular smooth muscle cell proliferation beneficial?
Lancet
(1996) - et al.
Effects of pravastatin sodium and simvastatin on plasma fibrinogen level and blood rheology in type II hyperlipoproteinemia
Atherosclerosis
(1996) - et al.
Statins do more than just lower cholesterol
Lancet
(1996) - et al.
Effects of atorvastatin and vitamin C on endothelial function of hypercholesterolemic patients
Atherosclerosis
(2000) - et al.
The A-to-Z trialmethods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of an early aggressive simvastatin therapy
Am Heart J
(2001) - et al.
Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP)
Am J Cardiol
(2001) Randomised trial of cholesterol lowering in 4444 patients with coronary heart diseasethe Scandinavian Simvastatin Survival Study (4S)
Lancet
(1994)- et al.
The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levelsCholesterol and Recurrent Events Trial investigators
N Engl J Med
(1996) Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels
N Engl J Med
(1996)
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individualsa randomised placebo-controlled trial
Lancet
Lipid-lowering therapy in acute coronary syndromes
JAMA
In-hospital initiation of lipid-lowering therapy for patients with coronary heart diseasethe time is now
Circulation
Early statin treatment following acute myocardial infarction and 1-year survival
JAMA
SYMPHONY and 2nd SYMPHONY InvestigatorsSibrafiban vs Aspirin to Yield Maximun Protection From Ischemic Heart Events Post-acute Coronary Syndromes: early statin initiation and outcomes in patients with acute coronary syndromes
JAMA
Cited by (0)
- ☆
Supported by Bristol-Myers Squibb, Australia.