Clinical Benefit of Statin Pretreatment in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background-Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. Methods and Results-We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (nϭ1692) or no statin/low-dose statin (nϭ1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase Ն3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, PϽ0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; PϽ0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; Pϭ0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interactionϭ0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (nϭ734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interactionϭ0.025). Conclusions-High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention. (Circulation. 2011;123:1622-1632.)Key Words: statins, HMG-CoA Ⅲ outcomes assessment Ⅲ protective agents Ⅲ meta-analysis Ⅲ stents P ercutaneous coronary intervention (PCI) represents the prevalent revascularization strategy in patients with coronary artery disease. Although this procedure is safe and is associated with low rates of severe complications, periprocedural myocardial infarction, as assessed by cardiac marker elevation, occurs in 5% to 40% of patients, depending on the definition applied, antithrombotic approaches, and clinical/ angiographic risk profile, [1][2][3][4] and it is well known that this complication may negatively impact clinical outcome after intervention. 2,3,5 Thus, various strategies, usually focused on Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received October 14, 2010; accepted February 14, 2011. Clinical Perspective on p 1632In the last few...

Markers of Endothelial Activation and Impaired Autonomic Function in Patients with Acute Coronary Syndromes – Potential Prognostic and Therapeutic Implication

“…Supports for this hypothesis are the results of the meta-analysis of Patti et al, who found that high-dose statin pretreatment before percutaneous coronary intervention leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events. It is noteworthy that the effect is most pronounced, but is not limited in patients with elevated markers of inflammatory activity [Patti et al, 2011]. Our findings must be confirmed by larger studies.…”

Influence of atherosclerosis‐related risk factors on serum high‐sensitivity C‐reactive protein levels in patients with type 2 diabetes: Comparison of their influence in obese and non‐obese patients

“…Furthermore, the Centers for Disease Control and Prevention and the American Heart Association gave the guidelines that we should use to measure hs‐CRP levels in patients who have cardiovascular risks21. Various new pharmacological approaches have been introduced to reduce hs‐CRP levels22, 23, 24, 25, 26. In order to assess the factors that largely influence hs‐CRP levels, here we examined how the accumulation of various atherosclerosis‐related risk factors influences serum hs‐CRP levels, and also tested which factors strongly influence hs‐CRP levels in patients with type 2 diabetes.…”

The Possibilities of Using a New Fixed-Dose Combination of Rosuvastatin and Acetylsalicylic Acid: Focus Groups of Patients

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