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Editor's Correspondence
January 27, 2003

The New Definition of Myocardial Infarction—Reply

Arch Intern Med. 2003;163(2):246. doi:10.1001/archinte.163.2.246-a

In reply. We would like to thank Drs Guerra and Szapary for highlighting an important issue with regard to the use of statins in the treatment of patients with acute coronary syndrome, and we appreciate the opportunity to clarify our data. While we noted a significantly lower 6-month mortality among patients diagnosed with acute myocardial infarction using the prior World Health Organization criteria (group A) compared with those diagnosed using the new European Society of Cardiology and American College of Cardiology criteria (group B), no difference in 6-month outcomes was observed after adjusting for age, sex, and patient characteristics. We have concluded that more comorbid conditions in group B may explain this observed mortality difference and that a more aggressive treatment approach may lead to improved outcomes. With respect to statins, their use was similar between patients in groups A and B, both at the time of admission (27% vs 33%; P = .36) and at discharge (60% vs 55%; P = .50). When statin use was forced into a multivariate logistic regression analysis, only age 70 years or older (odds ratio, 3.13; 95% confidence interval, 1.16-8.42) and troponin status (odds ratio, 2.90; 95% confidence interval, 1.08-7.81) were independently associated with death at 6 months, whereas statin use at discharge was associated with a trend toward reduced mortality (odds ratio, 0.40; 95% confidence interval, 0.15-1.06; P = .07). Despite the small sample size, our data are consistent with previously published trials indicating a mortality benefit with the use of statins after an acute coronary syndrome.1,2 Additionally, the use of statins did not diminish the utility of troponin as a potent prognostic indicator of the risk of death after an acute coronary syndrome.

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