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Dissonant and Resonant Notes From the SYMPHONY Trials

Karin B. Michels, ScD,MSc,MPH; Eugene Braunwald, MD

JAMA. 2002;287:3130-3132.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Can observational data substitute for randomized controlled trials for developing treatment recommendations and initiating public health interventions? This question arises from the article by Newby and colleagues¹ on the early initiation of statins in patients with acute coronary syndromes (ACS), reported in this issue of THE JOURNAL. The authors present results from an observational cohort study that indicate no difference in mortality and cardiovascular outcomes among patients with ACS who initiated statin treatment prior to hospital discharge and patients who did not receive statins.

Almost 2 million patients with ACS are discharged from US hospitals each year.² Since these patients are at high risk for recurrent events, secondary prevention is an important medical challenge. Randomized clinical trials (RCTs) have shown the benefits of aspirin, -blockers, and clopidogrel in these patients.² Furthermore, there is evidence that administration of these agents prior to hospital discharge . . . [Full Text of this Article]

Author Affiliations: Department of Epidemiology, Harvard School of Public Health (Dr Michels); Obstetrics and Gynecology Epidemiology Center (Dr Michels), and Department of Medicine (Drs Michels and Braunwald), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

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