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Early High-Dose Rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome: Results From Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Acute Kidney Injury and Myocardial Damage in Patients With Acute Coronary Syndrome (PRATO-ACS Study)
Study Questions:
What is the effect of high-dose rosuvastatin on contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS)?
Methods:
Consecutive statin-naive non–ST-elevation (NSTE)-ACS patients scheduled for early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on-admission followed by 20 mg/day) (statin group, n = 252) or no statin treatment (control group, n = 252). CI-AKI was defined as an increase in creatinine ≥0.5 mg/dl or ≥25% above baseline within 72 hours after contrast administration. Unconditional logistic analysis was performed to evaluate the efficacy of statin treatment on CI-AKI, adjusting for various potential prognostic and confounding factors (sex, age, diabetes, hypertension, low-density lipoprotein cholesterol level, creatinine clearance at baseline, left ventricular ejection fraction, contrast volume, CI-AKI risk score).
Results:
The incidence of CI-AKI was significantly lower in the statin group than in controls (6.7 vs. 15.1%; adjusted odds ratio, 0.38; 95% confidence interval, 0.20-0.71; p = 0.003). The benefits against CI-AKI were consistent even applying different CI-AKI definition criteria, and in all the prespecified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) was significantly lower in the statin group (3.6% vs. 7.9%; p = 0.036). Moreover, on admission, statin treatment was associated with a lower rate of death or nonfatal myocardial infarction at the 6-month follow-up (3.6% vs. 7.2%, p = 0.07).
Conclusions:
The authors concluded that on-admission high-dose rosuvastatin in statin-naive patients with ACS scheduled for an early invasive procedure can prevent CI-AKI and improve short-term clinical outcome.
Perspective:
This prospective, randomized study shows that in statin-naive patients with NSTE-ACS undergoing an early invasive strategy, the administration of high-dose rosuvastatin on admission resulted in a significantly lower incidence of CI-AKI and was associated with a better short-term clinical outcome. These results, together with studies that showed renal and myocardial protection following high-dose statins prior to percutaneous coronary intervention, support routine on-admission use of high-dose statin therapy in statin-naive patients with NSTE-ACS scheduled for an early invasive strategy. Additional studies are indicated to assess if reloading with high-dose statin may also augment renal protection in ACS patients already on chronic statin therapy.
Keywords: Fluorobenzenes, Myocardial Infarction, Stroke, Acute Coronary Syndrome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Acute Kidney Injury, Pyrimidines, Percutaneous Coronary Intervention, Cholesterol, Renal Dialysis, Dyslipidemias, Kidney Diseases, omega-Chloroacetophenone, beta-Alanine, Benzimidazoles, Cardiovascular Diseases, Stroke Volume, Hypertension, Diabetes Mellitus, Sulfonamides
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