Impact of statins preloading before PCI on periprocedural myocardial infarction among stable angina pectoris patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials

Soud, Mohamad; Ho, Gavin; Kuku, Kayode O.; Hideo‐Kajita, Alexandre; Waksman, Ron; García‐García, Héctor M.

doi:10.1016/j.carrev.2018.07.016

Cited by 11 publications

(4 citation statements)

References 25 publications

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“…This benefit is consistent for both Atorvastatin 80 mg and Rosuvastatin 40 mg, which are high-intensity statins. Compared to our meta-analysis, previous meta-analyses, although being more heterogeneous, conducted by Patti et al [ 30 ], Wang et al [ 5 ], Benjo et al [ 31 ], dan Soud et al [ 32 ] have shown that high-intensity statin pretreatment can substantially reduce MACE in patients undergoing PCI. This conclusion aligns with our meta-analysis, indicating lower incidence of MACE, including myocardial infarction and TVR, in cases of single high-dose statin administration before PCI.…”

Section: Discussioncontrasting

confidence: 57%

“…Additionally, Navarese et al [ 33 ] showed that the effect of statin varies with the timing of administration; the earlier statins are given before PCI, the greater the benefit, and statin treatment before PCI significantly reduces the onset of myocardial infarction compared to post-PCI treatment. Soud et al [ 32 ] emphasized that while pre-intervention statin use reduces MACE, the statistical significance of statin therapy before treatment in long-term mortality is not substantial. Conversely, our study indicates that single high-dose statin administration before PCI also provides benefits in terms of reducing all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

de Liyis,

Jagannatha,

Kosasih

et al. 2024

Egypt Heart J

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Background The impacts of single high-dose statin preloading in patients undergoing percutaneous coronary intervention (PCI) have not been fully examined. This study aims to evaluate post-procedure impacts of single high-dose statin pretreatment with acute coronary syndrome (ACS). Methods The meta-analysis reviewed Cochrane, PubMed, and Medline databases for studies comparing single high-dose atorvastatin or rosuvastatin to placebo in ACS patients undergoing PCI. The primary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), all-cause mortality, and target vessel revascularization (TVR) at three months. Secondary endpoints examined were the TIMI flow grade 3 and left ventricular ejection fraction (LVEF). Results Comprehensive analysis was conducted on fifteen RCTs, encompassing a total of 6,207 patients (3090 vs 3117 patients). The pooled results demonstrated that a single high-dose of statin administered prior to PCI led to a significant decrease in the incidence of MACE at three months post-PCI compared to the control group (OR 0.50, 95%CI 0.35–0.71, p = 0.0001). The occurrence of MI (OR 0.57, 95%CI 0.42–0.77, p = 0.0002), all-cause mortality (OR 0.56, 95%CI 0.39–0.81, p = 0.0002), and TVR (OR 0.56, 95%CI 0.35–0.92, p = 0.02) was significantly lower in the statin single high-dose group compared to the control group. No significant effects on TIMI flow grade 3 (OR 1.20, 95%CI 0.94–1.53, p = 0.14) or left ventricular ejection fraction (OR 2.19, 95%CI − 0.97 to 5.34, p = 0.17) were observed. Subgroup analysis demonstrated reduced incidence of MACE with a single dose of 80 mg atorvastatin (OR 0.66, 95%CI 0.54–0.81, p < 0.0001) and 40 mg rosuvastatin (OR 0.19, 95%CI 0.07–0.54, p = 0.002). Conclusions Single high-dose statin before PCI in patients with ACS significantly reduces MACE, MI, all-cause mortality, and TVR three months post-PCI.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

de Liyis,

Jagannatha,

Kosasih

et al. 2024

Egypt Heart J

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“…Pre-treatment with high-dose statin has been consistently shown to be beneficial in reducing the risk of complications and major adverse cardiac events after percutaneous coronary intervention (PCI) [ 182 , 183 ].…”

Section: Results - Consensus Statementsmentioning

confidence: 99%

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

AlShammeri¹,

Saif²,

Shehri³

et al. 2022

Journal of the Saudi Heart Association

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Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.

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“…However, statins exert additional advantageous cardiovascular effects, which are independent of their lipid-lowering effects, including improvement of endothelial function, antithrombotic effects, antioxidant effects, antiproliferative effects on smooth muscle cells, and anti-inflammatory effects [ 45 , 46 ]. Previous meta-analyses have shown that the use of statins during preloading in patients undergoing PCI significantly reduced the rates of periprocedural MI and Major Adverse Cardiovascular events (MACE) [ 47 , 48 ]. In non-ischaemic HF, atorvastatin significantly improves patients’ left ventricular ejection fraction (LVEF), which is thought to be due to attenuation of adverse left ventricular (LV) modelling [ 49 ].…”

Section: Statinsmentioning

confidence: 99%

Immunopharmacology of Post-Myocardial Infarction and Heart Failure Medications

Panahi

Vadgama

Kuganesan

et al. 2018

JCM

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The immune system responds to acute tissue damage after myocardial infarction (MI) and orchestrates healing and recovery of the heart. However, excessive inflammation may lead to additional tissue damage and fibrosis and exacerbate subsequent functional impairment, leading to heart failure. The appreciation of the immune system as a crucial factor after MI has led to a surge of clinical trials investigating the potential benefits of immunomodulatory agents previously used in hyper-inflammatory conditions, such as autoimmune disease. While the major goal of routine post-MI pharmacotherapy is to support heart function by ensuring appropriate blood pressure and cardiac output to meet the demands of the body, several drug classes also affect a range of immunological pathways and modulate the post-MI immune response, which is crucial to take into account when designing future immunomodulatory trials. This review outlines how routine post-MI pharmacotherapy affects the immune response and may thus influence post-MI outcomes and development towards heart failure. Current key drug classes are discussed, including platelet inhibitors, statins, β-blockers, and renin–angiotensin–aldosterone inhibitors.

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Impact of statins preloading before PCI on periprocedural myocardial infarction among stable angina pectoris patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials

Cited by 11 publications

References 25 publications

Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

Immunopharmacology of Post-Myocardial Infarction and Heart Failure Medications

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