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To the Editor: The results of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study reported by Dr Schwartz and colleagues¹ show that data on statins in acute coronary syndromes (ACS) need careful interpretation. Results of the MIRACL study showed no benefit on clinical end points (ie, death, nonfatal myocardial infarction, and cardiac arrest) but did show a reduction in symptomatic ischemic episodes requiring hospitalization. These results likely overstate the benefits of statin therapy, as patients who underwent percutaneous coronary intervention (PCI) during the trial period were excluded from the primary combined end point.

Coronary revascularization can be performed for symptomatic relief as has been demonstrated in many trials, including the Atorvastatin versus Revascularization Treatment (AVERT) study.² Results of the AVERT study showed a significant benefit of angioplasty in the reduction of symptoms of angina in patients who were treated with atorvastatin, 80 mg/d. Thus, to relegate the need . . . [Full Text of this Article]