Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome

Berwanger, Otávio; Santucci, Eliana Vieira; Silva, Pedro Gabriel Melo de Barros e; Jesuíno, Isabella de Andrade; Damiani, Lucas Petri; Barbosa, Lilian; Santos, Renato Hideo Nakagawa; Laranjeira, Lígia Nasi; Egydio, Flávia; Oliveira, Juliana Aparecida Borges de; Orto, Frederico Toledo Campo Dall; Andrade, Pedro Beraldo de; Bienert, Igor Ribeiro de Castro; Bosso, Carlos Eduardo da Costa Nunes; Mangione, José Armando; Polanczyk, Carísi Anne; Sousa, Amanda Guerra de Moraes Rego; Kalil, Renato A. K.; Santos, Luciano Nunes dos; Spósito, Andrei C.; Rech, Rafael Luiz; Sousa, Antônio Carlos Sobral; Baldissera, Felipe A.; Nascimento, Bruno Ramos; Giraldez, Roberto R.; Cavalcanti, Alexandre Biasi; Pereira, Sabrina Bernárdez; Mattos, Luiz Alberto; Armaganijan, Luciana; Guimarães, Hélio Penna; Sousa, J. Eduardo; Alexander, John H.; Granger, Christopher B.; Lópes, Renato D.

doi:10.1001/jama.2018.2444

Cited by 113 publications

(90 citation statements)

References 26 publications

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“…Our 30-day MACE rate following STEMI is much higher compared to reports from the Netherlands (3%), India (5%), and Brazil (10%) [26][27][28]. The in-hospital MACE rate was lower in our study population compared with results of recent studies from China (12%), Canada (9%), and India (8%) [27,29,30].…”

Section: Discussioncontrasting

confidence: 70%

In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

Akhtar

Aleem

Ghosh

et al. 2020

Preprint

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Background: There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information.Methods: We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of total death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE.Results: A total of 601 patients, mean age 51.6±10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8±2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI, 1.64–13.23).Conclusions: A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.

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Section: Discussioncontrasting

confidence: 70%

In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

Akhtar

Aleem

Ghosh

et al. 2020

Preprint

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“…[1][2][3] Previous small trials and systematic reviews that investigated the effect of loading doses of statins before and after PCI have suggested that there may be a reduction in periprocedural myocardial infarction (MI) and in major adverse cardiovascular events (MACE). [2][3][4][5][6] A well-powered study 7 that addressed the effect of loading doses of statin in patients with acute coronary syndrome (ACS) treated with or without PCI did not show clinical benefit in the overall ACS population but did suggest a positive effect in patients undergoing PCI. It is unknown whether timing of a pre-PCI loading dose of atorvastatin was associated with a beneficial treatment effect.…”

mentioning

confidence: 99%

Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

et al. 2018

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IMPORTANCE Loading doses of atorvastatin did not show reduction on clinical outcomes in the overall population of patients with acute coronary syndrome (ACS) enrolled in the Statins Evaluation in Coronary Procedures and Revascularization (SECURE-PCI) trial, but a potential benefit was identified in patients who subsequently underwent percutaneous coronary intervention (PCI). OBJECTIVES To determine whether periprocedural loading doses of atorvastatin are associated with decreased 30-day major adverse cardiovascular events (MACE) in patients with ACS undergoing PCI according to type of ACS and timing of atorvastatin administration before PCI. DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of a multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites that enrolled 4191 patients with ACS intended to be treated with PCI between April 18, 2012, and October 06, 2017. INTERVENTIONS Patients were randomized to 2 loading doses of 80 mg of atorvastatin or matching placebo before and 24 hours after a planned PCI. By protocol, all patients (regardless of treatment group) received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. MAIN OUTCOMES AND MEASURES The primary outcome was MACE through 30 days, composed by all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization. Cox regression models adjusting for key baseline characteristics were used to assess the association between atorvastatin and MACE in patients undergoing PCI. RESULTS Fromtheoveralltrialpopulation,2710(64.7%)underwentPCI(650women[24.0%];mean [SD] age, 62 [11.3] years). Loading atorvastatin was associated with reduced MACE at 30 days by 28% in the PCI group (adjusted hazard ratio [HR], 0.72; 95% CI 0.54-0.97; P = .03). Loading dose of atorvastatinwasadministeredlessthan12hoursbeforePCIin2548patients(95.3%)(45.1% < 2hours and 54.3% between 2 and 12 hours). There was no significant interaction between treatment effect and timing of study drug administration. The treatment effect of loading atorvastatin was more pronounced in patients with ST-segment elevation myocardial infarction than in patients with non-ST-segment elevation ACS (adjusted HR, 0.59; 95% CI, 0.38-0.92; P = .02; HR, 0.85; 95% CI, 0.58-1.27; P = .43, respectively). CONCLUSIONS AND RELEVANCE In patients with ACS undergoing PCI, periprocedural loading doses of atorvastatin appeared to reduce the rate of MACE at 30 days, primarily in patients with ST-segment elevation myocardial infarction. This beneficial effect seemed to be preserved and consistent, regardless of timing of atorvastatin administration, including within 2 hours before PCI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01448642

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“…Recently published study, the SECURE-PCI (Statins Evaluation in Coronary Procedures and Revascularization) trial was designed to assess the effect of periprocedural administration of statin in patients with ACS and planned coronary revascularization (13). The investigators sought to test an interesting hypothesis whether high dose atorvastatin before invasive management may reduce adverse cardiac events in ACS.…”

Section: Editorialmentioning

confidence: 99%

Timing of high intensity statin for acute coronary syndrome: how earlier initiation makes better?

Kim

Choi

2018

J. Thorac. Dis.

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Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome

Abstract: clinicaltrials.gov Identifier: NCT01448642.

Cited by 113 publications

References 26 publications

In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Timing of high intensity statin for acute coronary syndrome: how earlier initiation makes better?

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