Study Shows Clinical Benefit of Statin Pretreatment for PCI Patients

April 19, 2011—In Circulation, Giuseppe Patti, MD, et al published findings from a study that sought to evaluate the clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention (PCI) (2011;123:1622–1632).

According to the investigators, previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing PCI. However, most data were observational, and single randomized trials included limited numbers of patients.

As detailed in Circulation, the investigators performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3,341 patients received either high-dose statin (n = 1,692) or no/low-dose statin (n = 1,649) before PCI, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction (MI), defined as postintervention creatine kinase–MB increase three times the upper limit of normal, and 30-day major adverse cardiac events (death, MI, and target-vessel revascularization) were evaluated.

The investigators reported that the incidence of periprocedural MI was 7% in the high-dose statin group versus 11.9% in the control group, which corresponds to a 44% risk reduction (RR) in the active-treatment arm (odds ratio by fixed-effects model, 0.56; 95% confidence interval, 0.44–0.71; P < .00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% vs 12.6%; RR, 44%; P < .00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% vs 1.4%; P = .05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction = .43), was maintained across various subgroups, but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n = 734; RR, 68% for periprocedural MI vs 31% in 1,861 patients with normal C-reactive protein; P for quantitative interaction = .025).

High-dose statin pretreatment leads to a significant reduction in periprocedural MI and 30-day adverse events in patients undergoing PCI, the investigators concluded, and this strategy should be considered in all patients with planned PCI.