MIRACL Trial - atorvastatin in acute coronary syndrome

2001, Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA

MIRACL Trial Key Points:

  1. In addition to lowering the cholesterol and LDL levels, statins have been coined to lower the platelet aggregability, thrombus deposition and vascular inflammation as well.
  2. This observation led to the hypothesis that statins might be useful in lowering the recurrence of ischemic events after UA or NSTEMI.
  3. The MIRACL trial tested this hypothesis and showed 2.6% absolute reduction in recurrent ischemic events after early initiation of atorvastatin in patients who presented with UA or NSTEMI.

Guidelines changes

The 2014 ACC/AHA guidelines on NSTEMI recommends:

Initiate or continue high-intensity statin therapy in patients with no contraindications (Grade I, LOE: A)

Obtain a fasting lipid profile, preferably within 24 h (Grade IIa, LOE: C)