Emil L. Fosbol, MD, PhD; Christopher B. Granger, MD
In patients having percutaneous coronary intervention (PCI), does pretreatment with high-dose statins prevent periprocedural myocardial infarction (MI)?
Included studies compared high-dose statin pretreatment with control (no statin or low-dose statin pretreatment) in patients having PCI. Outcomes included periprocedural MI (in patients with stable angina or non–ST-segment elevation acute coronary syndrome: a postintervention increase in creatine kinase–MB [CK-MB] level ≥ 3 times the upper limit of normal [ULN]; in patients with ST-segment elevation MI: ≥ 20% increase from baseline CK-MB or troponin levels in the second sample drawn after 3 to 6 h) and myocardial injury (post-PCI elevation of troponin levels above the ULN).
Individual patient data meta-analysis of 12 randomized controlled trials (RCTs; n = 3141) that provided patient-level data. Sample size of trials ranged from 37 to 668 patients; 50% of patients were ≥ 65 years of age. 10 RCTs included only statin-naïve patients, 1 included statin-treated patients, and 1 included both. 7 trials used atorvastatin, 2 used rosuvastatin, 1 each used pravastatin and simvastatin, and 1 used 4 statins. Patients in both groups received statins after PCI.
Meta-analysis showed that pretreatment with high-dose statins reduced periprocedural MI and myocardial injury compared with control (Table).
In patients having percutaneous coronary intervention, pretreatment with high-dose statins prevents periprocedural myocardial infarction.
High-dose statin pretreatment vs control in patients having percutaneous coronary intervention (PCI)*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from odds ratios and control event rates in article.
†Post-PCI elevation of troponin levels above the upper limit of normal.
Emil L. Fosbol, Christopher B. Granger. Meta-analysis: High-dose statin pretreatment prevents periprocedural cardiac events in patients having PCI. Ann Intern Med. 2011;155:JC2–8. doi: 10.7326/0003-4819-155-4-201108160-02008
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Published: Ann Intern Med. 2011;155(4):JC2-8.
Cardiology, Coronary Risk Factors, Dyslipidemia.
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