Statins and unstable angina: MIRACL

Statins have demonstrated their aptitude to lower hypercholesterolemia; and to prevent the occurrence of arterial, coronary, and cerebral events, by p rimary and secondary prevention in patients with low or high risk to develo p coronary artery disease. In the first time, with MIRACL and Atrovastatine , statins are proposed in the therapeuty of unstable angina. This study was successful. In fact, in this comparative study, high dose of Atrovastatine (80 mg/day) administrated in the acute phase of non Q-wave myocardial infa rction or unstable angina, reduce ischemic events (RR = 0.84, p = 0.048). A fter anticoagulants and a wide group of platelets antiagregants, this stati n brings a new agent to the chemotherapy of the atherosclerotic unstable le sion. The TACTICS-TIMI 18 and the sub-group of the FR-ISC II study, demonst rate the necessity to stratify the unstable angina risk by electric and bio logic arguments. They confirm the efficacy of invasive strategy, with coron arography, and immediate revascularisation, in patients with high risk with persistent modifications of ST segment, and increasing Troponins level. Un der the cover of a large medical treatment composed of anti-ischemic, Aspir ine, LMWH, and now a high dose of statins, the acute coronary syndrome inva sive attitude must be guided by electric, biologic and the invasive attitud e prognostic risk.