Meta-Analysis on the Efficacy of High-Dose Statin Loading Before Percutaneous Coronary Intervention in Reducing No-Reflow Phenomenon in Acute Coronary Syndrome

Anayat, Sonia; Majid, Khansa; Nazir, Hafiza Saba; Nizami, Awais Ahmad; Mustafa, Waqar; Abbasi, Muhammad Sajid Rafiq; Ahsan, Muhammad; Jadoon, Sarosh Khan; Ullah, Irfan; Asghar, Muhammad Sohaib

doi:10.1016/j.amjcard.2023.02.024

Cited by 6 publications

(2 citation statements)

References 49 publications

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“…However, loading a single high-dose statin prior to PCI was not significantly associated with achieving TIMI flow grade 3 or LVEF values compared to the control. Previous meta-analyses have demonstrated the benefits of loading a single high-dose statin before PCI in preventing the no-reflow phenomenon in the ACS population [ 34 ]. However, this cannot be equated with the attainment of TIMI flow grade 3, as the primary goal of PCI itself is to achieve TIMI flow grade 3 [ 1 ].…”

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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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: 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

View full text Add to dashboard Cite

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“…High-dose statins immediately administered prior to PPCI were associated with improved TIMI flow, MBG, and ST-segment resolution compared to those who received them post-PPCI [ 46 ]. The underlying mechanisms behind these observations are unclear, but could be attributed to the pleotropic effects of statins in improving endothelial function, increasing nitric oxide bioavailability, antioxidant and anti-inflammatory properties, and plaque stabilization [ 47 ].…”

Section: Treatments For Microvascular Obstructionmentioning

confidence: 99%

Microvascular Obstruction in Acute Myocardial Infarction, a Potential Therapeutic Target

Ghobrial,

Bawamia,

Cartlidge

et al. 2023

JCM

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Microvascular obstruction (MVO) is a recognised phenomenon following mechanical reperfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI). Invasive and non-invasive modalities to detect and measure the extent of MVO vary in their accuracy, suggesting that this phenomenon may reflect a spectrum of pathophysiological changes at the level of coronary microcirculation. The importance of detecting MVO lies in the observation that its presence adds incremental risk to patients following STEMI treatment. This increased risk is associated with adverse cardiac remodelling seen on cardiac imaging, increased infarct size, and worse patient outcomes. This review provides an outline of the pathophysiology, clinical implications, and prognosis of MVO in STEMI. It describes historic and novel pharmacological and non-pharmacological therapies to address this phenomenon in conjunction with primary PCI.

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High-Intensity Statins Before Percutaneous Coronary Intervention in Acute Coronary Syndrome—Should It Be Added to Treatment Algorithm?

Cutlip¹

2023

The American Journal of Cardiology

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Meta-Analysis on the Efficacy of High-Dose Statin Loading Before Percutaneous Coronary Intervention in Reducing No-Reflow Phenomenon in Acute Coronary Syndrome

Cited by 6 publications

References 49 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

Microvascular Obstruction in Acute Myocardial Infarction, a Potential Therapeutic Target

High-Intensity Statins Before Percutaneous Coronary Intervention in Acute Coronary Syndrome—Should It Be Added to Treatment Algorithm?

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