Ten RCTs were included (8,052 patients, range 69 to 3,408).
When studies were pooled, treatment with statins had no significant effect on mortality compared to placebo or usual care (OR 0.80, 95% CI 0.58 to 1.12; Ι²=0%; seven RCTs). When the analysis was repeated to include the three RCTs with no events in either arm the effect estimate was almost identical.
Subgroup analysis: Statins initiated within 24 hours of acute coronary syndrome significantly reduced mortality (OR 0.63, 95% CI 0.41 to 0.99; five RCTs). Initiation at day two (three RCTs) or day three (two RCTs) did not significantly influence mortality. There was no significant interaction across subgroups for mortality risk (p=0.303).