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.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Anticoagulation Management and ACS, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Hypertension

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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