Effect of High-Dose Statin Pretreatment for Myocardial Perfusion in Patients Receiving Percutaneous Coronary Intervention (PCI): A Meta-Analysis of 15 Randomized Studies
Yun Xiao, Shuyi He, Zhiwei Zhang, Hongjian Feng, Sini Cui, Jun Wu
(Division of Nephrology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland))
Med Sci Monit 2018; 24:9166-9176
For coronary artery disease, percutaneous coronary intervention (PCI) is the preferred treatment. Reperfusion injury is a common and serious complication of PCI. Studies showed that early statin therapy has a favorable prognostic impact for patients undergoing PCI. However, the effects of statins on improving post-PCI myocardial perfusion are still unclear. In this study we evaluated the potential effect of high-dose statin pretreatment on postprocedure myocardial perfusion and MACE rate in patients receiving PCI.
MATERIAL AND METHODS: We searched randomized controlled trials that evaluated the effect of high-dose statin pretreatment on post-PCI TIMI flow grade and MACE in patients undergoing PCI from the databases of PubMed, Embase, and Cochrane Library. All data were pooled for analysis and were stratified by type of statin, clinical presentation, and current statin therapy status in subgroup.
RESULTS: Fifteen RCTs with 4240 individuals were selected. The pooled analysis showed that high-dose statin pretreatment before PCI significantly improved the final TIMI flow grade compared with the control group (OR=0.61, 95% CI: 0.46 to 0.80, p=0.0005), and showed reduced incidence of MACE (OR=0.53, 95%CI: 0.39 to 0.71, p<0.0001). In subgroup analysis, the beneficial effect of high-dose statin was significant in statin-naive treatment patients, ACS patients, and patients on atorvastatin therapy, but no difference occurred in rosuvastatin, previous statin therapy, and stable angina patients.
CONCLUSIONS: High-dose statin pretreatment has an important effect on postprocedure myocardial perfusion by improving the TIMI flow in patients undergoing PCI, and high-dose statin preloading also reduces the incidence of MACE.
Keywords: Cardiology, myocardial perfusion imaging, Nephrology