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Clinical Benefit of Statin Pretreatment in Patients Undergoing Percutaneous Coronary Intervention: A Collaborative Patient-Level Meta-Analysis of 13 Randomized Studies
Study Questions:
What is the clinical benefit of statin pretreatment in the setting of percutaneous coronary intervention (PCI), in reducing periprocedural myocardial infarction (MI) and major adverse cardiac events (MACE) at 30 days?
Methods:
The investigators performed a collaborative meta-analysis using individual patient data from 13 randomized studies, in which 3,341 patients received before PCI either high-dose statin (N = 1,692) versus no statin/low-dose statin (N = 1,649), with all patients having statin therapy following intervention. Occurrence of periprocedural MI, defined as post-intervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day MACE(death, MI, target vessel revascularization) were evaluated. Thirty-day cardiac event analysis was performed by the Kaplan-Meier method with log-rank test group comparison.
Results:
Incidence of periprocedural MI was 7.0% in the high-dose statin versus 11.9% in the control group, corresponding to 44% risk reduction in the active treatment arm (odds ratio by fixed effects model, 0.56; 95% confidence interval [CI], 0.44-0.71; p < 0.00001). MACE rate at 30 days was significantly lower in the high-dose statin group (7.4% vs. 12.6%; 44% risk reduction; p < 0.00001), and 1-month MACE excluding periprocedural events was also reduced (0.6% vs. 1.4%; p = 0.05). Benefit of high-dose statins was irrespective of clinical presentation (p for interaction = 0.43) and maintained across various subgroups, but appeared greater in the subgroup with elevated baseline C-reactive protein (CRP) levels (n = 734; 68% risk reduction of periprocedural MI vs. 31% in those 1,861 patients with normal CRP; p for quantitative interaction = 0.025).
Conclusions:
The authors concluded that high-dose statin pretreatment leads to a significant reduction in periprocedural MI and 30-day adverse events in patients undergoing PCI.
Perspective:
This collaborative patient-level meta-analysis demonstrates that pretreatment with high-dose statins significantly reduces the risk of adverse cardiac events and periprocedural MI in patients undergoing PCI. The finding was present both in patients who were undergoing PCI following acute coronary syndrome as well as in those with stable angina. In addition, the benefit was observed in patients receiving dual antiplatelet therapy as well as in those receiving triple antiplatelet therapy. The consistency across the trials and strength of the effect observed in this meta-analysis suggest that a strategy of high-dose statin pretreatment is reasonable in all patients undergoing PCI, irrespective of clinical presentation and chronic statin therapy.
Keywords: Incidence, Myocardial Infarction, Acute Coronary Syndrome, Angina, Stable, Percutaneous Coronary Intervention
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