6/28/23, 11:16 PM MIRACL Pathway Feedback Search Clinical Topics Home Studies MIRACL MIRACL Disease Non-ST-elevation myocardial inf Trial question What is the role of atorvastatin in patients (aged 18 years) with unstable angina or non-Q-wave acute myocardial infarction? Study design Multi-center Double blinded RCT Population Characteristics of study participants 35.0% female N = 3086 65.0% male 3086 patients (1074 female, 2012 male) Inclusion criteria: patients (aged 18 years) with unstable angina or non-Q-wave acute myocardial infarction Key exclusion criteria: Q-wave acute myocardial infarction within the preceding 4 weeks, left bundle-branch block or paced ventricular rhythm, severe congestive HF, severe anemia, renal failure requiring dialysis, or hepatic dysfunction Interventions N=1538 atorvastatin (80 mg/day between 24 to 96 hours after hospitalization) N=1548 placebo (matching placebo between 24 and 96 hours after hospitalization) https://web.pathway.md/studies/recKv5W6kPoetWJzJ 1/2 6/28/23, 11:16 PM MIRACL Pathway Primary outcome Death, nonfatal myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia requiring emergency hospitalization 17.4 % 17.4 14.8 13.0 % 8.7 % 4.3 % Borderline significant decrease 0.0 % Atorvastatin Placebo Borderline significant decrease in death, nonfatal myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia requiring emergency hospitalization (14.8% vs. 17.4%; RR 0.84, 95% CI 0.7 to 1) Secondary outcomes Significant decrease in symptomatic ischemia with objective evidence and requiring emergency rehospitalization (6.2% vs. 8.4%; RR 0.74, 95% CI 0.57 to 0.95) Significant increase in abnormal liver transaminases (2.5% vs. 0.6%; RR 4.17, 95% CI 1.7 to 6.64) Safety outcomes Significant differences in abnormal liver transaminases (2.5% vs. 0.6%, p < 0.001). Conclusion In patients (aged 18 years) with unstable angina or non-Q-wave acute myocardial infarction, atorvastatin was superior to placebo with respect to death, nonfatal myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia requiring emergency hospitalization. Reference Schwartz GG, Olsson AG, Ezekowitz MD et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001 Apr 4;285(13):1711-8. Open reference URL https://web.pathway.md/studies/recKv5W6kPoetWJzJ 2/2