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Loading Dose of Atorvastatin and MACE in ACS Patients
Study Questions:
What are the effects of a loading dose of atorvastatin (80 mg) versus control therapy before percutaneous coronary intervention (PCI) on major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS)?
Methods:
The investigators identified randomized controlled trials comparing a loading dose of atorvastatin to a control in patients with ACS who underwent PCI through searches of medical literature databases. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the primary endpoint. In this study, Dersimonian and Laird random effects model was performed to assess the effect between the two groups.
Results:
Thirteen trials enrolling 22,095 patients were included; of these, 11,214 (50.7%) received loading doses of 80 mg of atorvastatin. Compared with the control, atorvastatin significantly reduced MACE (RR, 0.66; 95% CI, 0.54-0.80), myocardial infarction (MI; RR, 0.61; 95% CI, 0.46-0.80), revascularization (RR, 0.76; 95% CI, 0.69-0.83), and stroke (RR, 0.69; 95% CI, 0.49-0.96). There was no difference in death or rehospitalization between the two groups. In the subgroup analysis, atorvastatin still significantly reduced MACE (RR, 0.57; 95% CI, 0.39-0.85) and MI (RR, 0.61; 95% CI, 0.42-0.89) within 30 days. Furthermore, atorvastatin still remarkably reduced MACE (RR, 0.70; 95% CI, 0.55-0.89), MI (RR, 0.58; 95% CI, 0.36-0.95), and revascularization (RR, 0.76; 95% CI, 0.69-0.84) after >30 days. No significant differences were observed in death or stroke within 30 days or after >30 days.
Conclusions:
The authors concluded that a loading dose of atorvastatin markedly reduces cardiovascular events in patients with ACS.
Perspective:
This study reports that a loading dose of atorvastatin (80 mg) before PCI can significantly reduce the incidence of MACE, MI, revascularization, and stroke. Furthermore, a loading dose of atorvastatin remarkably reduced MACE, MI, and revascularization even after >30 days. No significant difference was observed in death or stroke within 30 days or after >30 days. These data further support the 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation ACS, which recommends that high-intensity statin therapy should be initiated or continued in all patients with ACS and no contraindications to its use. Essentially all patients with ACS should receive a high-intensity statin unless contraindicated.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and ACS
Keywords: Acute Coronary Syndrome, Drug Therapy, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Secondary Prevention, Stroke
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