If you had to pick an acute coronary syndrome to have, it wouldn’t be a STEMI, and a recent study from the Archives of Internal Medicine showed that using aspirin, statins, beta blockers and ACE-inhibitors before hospital admission for an acute coronary syndrome reduced the risk of presenting with it.
With over 100,000 patients from a Swedish registry (RIKS-HIA), there are some significant results. Firstly, a pat on the back for reducing mortality – 30-day STEMI mortality was 13% in 1996, and dropped to 5.6% in 2006, with a similar decreased for NSTEMI mortality.
If you look at the baseline characteristics of patients presenting with STEMI, less of them were on aspirin, beta blockers,statins and ACE-inhibitors, reinforcing the message that for patients with coronary risk factors, primary prevention is important, and part of the current guidelines, as well as important post acute coronary syndrome.
Diabetes is a significant coronary risk factor, and you may remember from before that “…the effect of aspirin for primary prevention of CVD events in adults with diabetes is unclear…” – but they did say at the time that you need diabetes + another coronary risk factor before considering aspirin for primary prevention (generally – see here). Don’t forget – for patients with no coronary risk, aspirin is not recommended.
This is core clinical cardiology – the “SAAB (statins, aspirin, ACE-i, and beta blocker)” combination is clearly useful in those patients with coronary risk factors, and significantly reduces the chance of your MI being a STEMI vs. a NSTEMI. Read more about it over at the Archives here.
IMAGE: Wikimedia Commons