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Pourhosseini H, Lashkari R, Aminorroaya A, Soltani D, Jalali A, Tajdini M. Effects of high dose atorvastatin before elective percutaneous coronary intervention on highly sensitive troponin T and one year major cardiovascular events; a randomized clinical trial. IJC HEART & VASCULATURE 2019; 22:96-101. [PMID: 30671535 PMCID: PMC6328087 DOI: 10.1016/j.ijcha.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/20/2023]
Abstract
Introduction Some studies have demonstrated that post-PCI elevated cardiac enzymes are associated with worse outcomes. In this study, we aimed to determine if high-dose treatment with atorvastatin before planned elective PCI reduces PMI or MACE at 1-year median follow-up. Material and methods Eligible participants were randomly allocated to group A (80 mg atorvastatin 12 h and 40 mg 2 h before PCI) and group B (40 mg atorvastatin daily). Blood samples were obtained before and at 24 h after PCI to measure hsTnT. All patients were followed regarding MACE (combination of death, re-hospitalizations for ACS, and unplanned coronary revascularization) during one year after PCI. Results 207 patients randomly assigned to Group A (n = 97) or group B (n = 110). The rate of PMI was lower in group A (5.2%) compared to group B (10.9%); despite near to 50% lower rate of PMI in group A, binary logistic regression showed no significant association between atorvastatin recapture and PMI. The occurrence of MACE in 97 patients of group A was 11 (11.3%), higher than 11 (10%) cases of 110 patients in group B. Cox proportional hazards regression model shows no significant difference in MACE of study groups. Conclusion Pretreatment of patients with stable angina who were planned to undergo an elective PCI with 120 mg of atorvastatin before the procedure confer them the same benefit in terms of PMI and MACE as 40 mg routine daily dosage of this statin does.
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Affiliation(s)
- HamidReza Pourhosseini
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Lashkari
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Danesh Soltani
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center and School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Ave., Tehran, Iran
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Soud M, Ho G, Kuku KO, Hideo-Kajita A, Waksman R, Garcia-Garcia HM. 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. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:971-975. [PMID: 30056022 DOI: 10.1016/j.carrev.2018.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022]
Abstract
It has been shown that statins preloading, before percutaneous coronary intervention (PCI), may reduce the risk of cardiovascular outcomes for acute coronary syndrome patients. Nevertheless, the effect of such pretreatment among patients with stable angina pectoris (SAP) is still debatable. We performed a systematic review and updated meta-analysis of the literature to evaluate the efficacy of short-term statins preloading on periprocedural myocardial infarction (PMI) incidence and mortality after PCI. We included 13 randomized control trials that examined statins preloading in adult patients with SAP undergoing PCI. While the use of preloading statins significantly reduced PMI, the benefit of statins pretreatment on long-term mortality was not statistically significant. SHORT SUMMARY: High dose statins preloading prior to elective PCI was associated with a significant reduction in PMI in SAP patients. The mortality benefit of such intervention will need to be addressed by further large randomized studies. The routine use of statins in stable patients before PCI should be considered if no contraindications are present.
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Affiliation(s)
- Mohamad Soud
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gavin Ho
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Alexandre Hideo-Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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Han X, Zhang Y, Yin L, Zhang L, Wang Y, Zhang H, Li B. Statin in the treatment of patients with myocardial infarction: A meta-analysis. Medicine (Baltimore) 2018; 97:e0167. [PMID: 29561426 PMCID: PMC5895306 DOI: 10.1097/md.0000000000010167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this meta-analysis is to investigate whether statin is a key therapy for myocardial infarction (MI) by comparing all randomized controlled trials that appraised the effects of statin on risk of MI.Pubmed, Embase, and Medline databases (up to December 2016) were used to search all related articles. Using the data from 18 available publications, we examined the efficacy in treating or reducing the risk of MI by using random-effects models of odds ratio (OR) comparing the highest with the lowest category.Statins have demonstrated efficacy in treating or reducing the risk of MI (OR = 0.73, 95% confidence interval = 0.58-0.93, P = .010).This meta-analysis suggests that statin have light efficacy in treating or reducing the risk of MI patients.
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Zhai C, Cong H, Liu Y, Zhang Y, Liu X, Zhang H, Ren Z. Effect of High-Dose Statin Pretreatment on the Incidence of Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention: Grading the Evidence Through a Cumulative Meta-analysis. Clin Cardiol 2015; 38:668-78. [PMID: 26442621 DOI: 10.1002/clc.22471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/30/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Previous studies have showed that high-dose statin pretreatment could reduce the incidence of periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI). However, previous analyses have not performed reliable grading of evidence. HYPOTHESIS In previous analyses, it supposed that the high-dose statin pretreatment was effective in reduction of the rate of PMI. In this analysis, we evaluated the effect of high-dose statin pretreatment on the reduction of rate of PMI based on a cumulative meta-analysis and grading of evidence. METHODS We assembled the relevant published randomized controlled trials that compared the efficacy of high-dose statin pretreatment prior to PCI. We evaluated the risk of PMI by a cumulative meta-analysis, with subgroups stratified by clinical classifications and different statin histories, and we conducted explicit grading of evidence. RESULTS High-dose statin pretreatment caused a 55% reduction in PMI through this cumulative meta-analysis of 23 RCTs (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.37-0.54). The effect of high-dose statin pretreatment was significant for the stable angina subgroup (OR: 0.42, 95% CI: 0.32-0.56), ACS subgroup (OR: 0.43, 95% CI: 0.29-0.64), and the mixed presentation subgroup (OR: 0.50, 95% CI: 0.36-0.70). In different statin therapy histories, high-dose statin pretreatment reduced incidence of PMI 55% in the statin-naive subgroup (OR: 0.45, 95% CI: 0.36-0.56) and 54% in the low-dose statin subgroup (OR: 0.46, 95% CI: 0.32-0.66). The GRADE system indicated that the overall evidence quality was moderate. This finding may strengthen the confidence in any recommendations. CONCLUSIONS High-dose statin pretreatment can reduce the rate of PMI, irrespective of either the clinical presentation or previous statin-treatment history. Importantly, the overall GRADE evidence quality was moderate.
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Affiliation(s)
- ChuanNan Zhai
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.,Department of Cardiology, Tianjin Gongan Hospital, Tianjin, China
| | - HongLiang Cong
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - YuJie Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ying Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - XianFeng Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - ZhiJing Ren
- Graduate School, Tianjin Medical University, Tianjin, China
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Martins KB, Mattos LA, Sousa AG, Sousa JM, Abzaid A, Feres F, de Ribamar JC, Staico R, Costa RA, Chaves AJ. A Randomized Trial of Creatine-kinase Leak After Rosuvastatin in Elective Percutaneous Coronary Intervention (CLEAR-PCI). J Interv Cardiol 2015; 28:339-47. [DOI: 10.1111/joic.12209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kleber B.A. Martins
- Instituto Dante Pazzanese de Cardiologia; Interventional Cardiology; Sao Paulo Brazil
| | - Luiz A.P. Mattos
- Instituto Dante Pazzanese de Cardiologia; Interventional Cardiology; Sao Paulo Brazil
| | | | | | | | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia; Interventional Cardiology; Sao Paulo Brazil
| | | | - Rodolfo Staico
- Dante Pazzanese Institute of Cardiology; Sao Paulo Brazil
| | - Ricardo A. Costa
- Instituto Dante Pazzanese de Cardiologia; Interventional Cardiology; Sao Paulo Brazil
| | - Aurea J. Chaves
- Instituto Dante Pazzanese de Cardiologia; Interventional Cardiology; Sao Paulo Brazil
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Wang L, Peng P, Zhang O, Xu X, Yang S, Zhao Y, Zhou Y. High-dose statin pretreatment decreases periprocedural myocardial infarction and cardiovascular events in patients undergoing elective percutaneous coronary intervention: a meta-analysis of twenty-four randomized controlled trials. PLoS One 2014; 9:e113352. [PMID: 25473831 PMCID: PMC4256370 DOI: 10.1371/journal.pone.0113352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/22/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. METHODS We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. RESULTS Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45-0.83; P = 0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50-0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12-0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34-0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45-1.10; P = 0.12). Long-term effects on survival were less obvious. CONCLUSIONS High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome.
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Affiliation(s)
- Le Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Pingan Peng
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Ou Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Xiaohan Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Shiwei Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Yingxin Zhao
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
| | - Yujie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing 100029, China
- * E-mail:
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Benjo AM, El-Hayek GE, Messerli F, DiNicolantonio JJ, Hong MK, Aziz EF, Herzog E, Tamis-Holland JE. High dose statin loading prior to percutaneous coronary intervention decreases cardiovascular events: A meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2013; 85:53-60. [DOI: 10.1002/ccd.25302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Alexandre M. Benjo
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
- Ochsner Medical Center; New Orleans Louisiana
| | - Georges E. El-Hayek
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
| | - Franz Messerli
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
| | - James J. DiNicolantonio
- Saint Luke's Mid America Heart Institute; Kansas City, Missouri and Wegmans Pharmacy; Ithaca New York
| | - Mun K. Hong
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
| | - Emad F. Aziz
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
| | - Eyal Herzog
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
| | - Jacqueline E. Tamis-Holland
- St. Luke's and Roosevelt Hospitals and Columbia University; College of Physicians and Surgeons; New York New York
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8
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Guay J, Ochroch EA. Effects of adding statins before surgery on mortality and major morbidity: a meta-analysis. J Cardiothorac Vasc Anesth 2013; 28:255-66. [PMID: 24011872 DOI: 10.1053/j.jvca.2013.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To re-evaluate the effects of adding a statin before surgery on mortality at 30 days and at 1 year and on major morbidity at 0-30 days. DESIGN A meta-analysis of parallel, randomized, controlled trials published in English. SETTING A university-based electronic search. PARTICIPANTS Adult patients undergoing any type of procedure. INTERVENTION Adding a statin before a procedure compared to a placebo or no intervention. MEASUREMENTS AND MAIN RESULTS A search for all randomized controlled trials (RCT) was done in PubMed, Embase, Ovid MEDLINE and the Cochrane Central Register of Controlled Trials in November 2012. The quality of each study was assessed with the Cochrane Collaboration Tools. An I-square ≥ 25% was chosen as the cut-off point for heterogeneity exploration. The search produced 29 trials. Statins reduced the 0-30 days' risk of myocardial infarction: risk ratio (RR) 0.48 (95%CI 0.38, 0.61); I-square 13.2%; p<0.001; number needed-to-treat 17 (14, 24). There were no statistical differences at 0-30 days for stroke RR 0.70 (0.25, 1.95), acute renal insufficiency RR 0.54 (0.26, 1.12) or reoperation RR 1.10 (0.51, 2.38). There was a trend for a reduced mortality at 1 year RR 0.26 (0.06, 1.02); I-square 0%; p = 0.053. The hospital length of stay was slightly decreased with atorvastatin: standardized mean difference (SMD) -0.27 (-0.39, -0.14), p<0.001; fluvastatin SMD -0.95 (-1.56, -0.34), p = 0.002; and rosuvastatin SMD -0.69 (-0.98, -0.40), p<0.001 but not with simvastatin SMD -0.04 (-0.41, 0.48). CONCLUSIONS Adding a statin before a high risk cardiac procedure reduces the 0-30 days' risk of myocardial infarction.
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Affiliation(s)
- Joanne Guay
- Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada.
| | - E Andrew Ochroch
- Department of Anesthesiology, University of Pennsylvania Health System, Philadelphia, PA
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Leoncini M, Toso A, Maioli M, Tropeano F, Bellandi F. Statin treatment before percutaneous cononary intervention. J Thorac Dis 2013; 5:335-42. [PMID: 23825770 DOI: 10.3978/j.issn.2072-1439.2013.05.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 05/13/2013] [Indexed: 12/31/2022]
Abstract
Treatment with 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) improves short-and-long term prognosis in high-risk patients with stable coronary artery disease and in those with acute coronary syndrome and their use is strongly recommended for secondary prevention. Moreover, recent data suggest that statin pre-treatment is associated with a better short- and long-term outcome in patients undergoing percutaneous coronary intervention. Current guidelines for coronary revascularization recommend the use of high-dose of statins before percutaneous coronary intervention to reduce the risk of periprocedural myocardial infarction in statin naïve patients (class IIa A) and in those on chronic statin therapy (class IIa B). However, the beneficial clinical effects elicited by statins in patients undergoing coronary angioplasty may arise not only from a cardiac protection against periprocedural myocardial injury but also from a renal protection against acute kidney injury caused by iodinated contrast media. Actually, statins exert multiple non-lipid lowering (pleiotropic) effects, including improved endothelial function, reduced inflammatory and immuno-modulatory processes, oxidative stress and platelet adhesion, that may contribute to both cardio- and nephro-protection even in the short-term.
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Takano H, Ohba T, Yamamoto E, Miyachi H, Inui K, Kawanaka H, Kamiya M, Kikuchi A, Takahashi Y, Tanabe J, Inami S, Takagi G, Asai K, Yasutake M, Ibuki C, Tanaka K, Kusama Y, Seino Y, Munakata K, Mizuno K. Usefulness of rosuvastatin to prevent periprocedural myocardial injury in patients undergoing elective coronary intervention. Am J Cardiol 2013; 111:1688-93. [PMID: 23507709 DOI: 10.1016/j.amjcard.2013.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to investigate whether percutaneous coronary intervention-related periprocedural myocardial infarction (MI) can be suppressed more significantly with high- compared with low-dose rosuvastatin. A total of 232 patients scheduled to undergo elective percutaneous coronary intervention within 5 to 7 days were assigned to groups that would receive either 2.5 or 20 mg/day of rosuvastatin (n = 116 each). The incidence of periprocedural MI did not significantly differ between the high and low-dose groups (8.7% vs 18.7%, p = 0.052). In patients who were not taking statins at the time of enrollment, high-dose rosuvastatin significantly suppressed periprocedural MI compared with the low dose (10.5% vs 30.0%, p = 0.037). The difference was not significant in patients who were already taking statins (high vs low dose 7.6% vs 10.6%, p = 0.582). In conclusion, the incidence of percutaneous coronary intervention-related periprocedural MI was reduced more effectively by high-dose than by low-dose rosuvastatin in statin-naive patients. However, low-dose rosuvastatin is sufficient for patients who are already taking statins.
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Affiliation(s)
- Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
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11
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Ndrepepa G, King L, Cassese S, Fusaro M, Tada T, Schömig A, Kastrati A. Prehospital statin therapy and one-year mortality in patients with stable coronary artery disease undergoing percutaneous coronary intervention. Eur J Intern Med 2013. [PMID: 23182629 DOI: 10.1016/j.ejim.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Statins have multiple effects in patients with coronary artery disease. No studies have investigated whether chronic statin pretreatment before percutaneous coronary intervention (PCI) has an impact on long-term mortality in patients with stable angina. METHODS The study included 8041 patients with stable angina. At the time of PCI, 5939 patients (73.8%) were receiving statins for ≥ 1 month before procedure and 2102 patients (26.2%) were not receiving statins. The primary outcome analysis was 1-year mortality. RESULTS There were 192 deaths during the follow-up: 119 deaths among patients receiving statins and 73 deaths among patients not receiving statins (Kaplan-Meier estimates of 1-year mortality 2.06% and 3.59%; unadjusted hazards ratio [HR]=0.56, 95% confidence interval [CI] 0.42-0.75; P<0.001). Landmark analysis showed that almost all mortality benefit occurred in the first 30-days after PCI: 10 deaths among patients receiving statins and 22 deaths among patients not receiving statins (Kaplan-Meier estimates of 30-day death, 0.17% and 1.06%, respectively; HR=0.16, 95% CI 0.08-0.34, P<0.001). No significant difference in mortality according to statin pretreatment between 30 days and 1 year was observed (109 deaths among patients receiving statins vs 51 deaths among patients not receiving statins; Kaplan-Meier estimates 1.89% and 2.53%; HR=0.75, 95% CI 0.53-1.05, P=0.095). After adjustment in the Cox proportional hazards model, statin pretreatment was associated with a 35% reduction in the adjusted risk for 1-year mortality (adjusted HR=0.65, 95% CI 0.44-0.98, P=0.039). CONCLUSIONS Pretreatment with statins before PCI was associated with a significant reduction of 1-year mortality in patients with stable angina.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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12
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Patti G. Short-term high-dose atorvastatin for periprocedural myocardial infarction prevention in patients with renal dysfunction. J Cardiovasc Med (Hagerstown) 2011; 12:305-8. [DOI: 10.2459/jcm.0b013e3283454faa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Patti G, Cannon CP, Murphy SA, Mega S, Pasceri V, Briguori C, Colombo A, Yun KH, Jeong MH, Kim JS, Choi D, Bozbas H, Kinoshita M, Fukuda K, Jia XW, Hara H, Cay S, Di Sciascio G. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies. Circulation 2011; 123:1622-32. [PMID: 21464051 DOI: 10.1161/circulationaha.110.002451] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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 (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 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, P<0.00001). 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; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). 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.
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Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy.
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14
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Winchester DE, Wen X, Xie L, Bavry AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 2010; 56:1099-109. [PMID: 20825761 DOI: 10.1016/j.jacc.2010.04.023] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/23/2010] [Accepted: 04/05/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. BACKGROUND Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction (MI) and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. METHODS We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural MI (risk ratio [RR]: 0.57, 95% confidence interval [CI]: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (RR: 0.66, 95% CI: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (RR: 0.54, 95% CI: 0.43 to 0.68, p < 0.0001). CONCLUSIONS Statins administered before invasive procedures significantly reduce the hazard of post-procedural MI. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered.
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Zhang F, Dong L, Ge J. Effect of statins pretreatment on periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: a meta-analysis. Ann Med 2010; 42:171-7. [PMID: 20384433 DOI: 10.3109/07853890903463976] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Periprocedural myocardial injury remains the most common complication associated with percutaneous coronary intervention (PCI). Previous studies have demonstrated that even a small elevation of cardiac enzymes is associated with higher risk of mortality during follow-up. OBJECTIVE We performed a meta-analysis based on all currently available randomized controlled trials (RCT) to evaluate the beneficial effects of hydroxymethylglutaryl-CoA reductase inhibitors (statins) given before PCI on preventing periprocedural myocardial infarction (MI). METHODS The published literature was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) and conference proceedings up through August 2009. RCTs were eligible for inclusion if they compared preprocedural statins versus placebo treatment in patients not taking statins previously but scheduled for PCI and had the data of periprocedural MI reported by the trial investigators. RESULTS Prespecified criteria were met by 6 RCTs involving 2,088 patients. During the periprocedural period, 81 of 1,051 patients (7.7%) in the statins pretreatment group developed periprocedural MI, significantly less than 147 of 1,037 (14.2%) patients assigned to the control group (OR 0.51, 95% CI 0.38-0.67; P< 0.001). During 1-month follow-up, only 4 deaths, 7 non-periprocedural Q-wave MIs, and 4 revascularizations occurred in all 2,088 enrolled patients. The composite of death, MI, or target vessel revascularization at 1 month, essentially driven by periprocedural MI, was reported in 8.0% in the statins pretreatment group and 15.3% in the control group (OR 0.48, 95% CI 0.36-0.64; P< 0.001). CONCLUSIONS This meta-analysis supports the effectiveness of statins pretreatment on reducing the rate of periprocedural MI in patients undergoing PCI.
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Affiliation(s)
- Feng Zhang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
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