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Cardiology: High-Dose Statins Reduce Post-PCI Adverse Events

Patients reaped benefits regardless of clinical presentation

Offering pre-treatment with high-dose statins prior to percutaneous coronary intervention (PCI) significantly reduced periprocedural myocardial infarction (MI) and 30-day adverse events, according to the results of a study published recently in Circulation.

Although PCI is safe and has low rates of severe complications, periprocedural MI occurs in 5 to 40 percent of patients. Researchers have investigated improving antithrombotic therapy to decrease the incidence of cardiac ischemic events during PCI. The authors undertook the current meta-analysis after finding limited existing research.

The authors drew on 13 randomized studies to compare 3,341 patients who received either high-dose statins or no statins/low-dose statins prior to PCI. All patients received statins post-procedure. The authors evaluated the occurrence of periprocedural MI, defined as post-intervention creatinine kinase-MB increase of at least three times the upper limit of normal, and 30-day major adverse cardiac events (MACE, defined as death, myocardial infarction, or target-vessel revascularization). The incidence of periprocedural MI was 7.0 percent in the high-dose statin group compared to 11.9 percent in the low-dose statin group, which corresponds to a 44 percent risk reduction in the active-treatment arm. The rate of MACE at 30 days was 7.4 percent in the high-dose group compared to 12.6 percent of controls. One-month MACE, excluding periprocedural events, were 0.6 percent in the high-dose statin group compared to 1.4 percent of controls. High-dose statins provided this benefit regardless of initial presentation. It was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels.

The authors conclude that the results of the current study “suggest that a strategy of high-dose statin pretreatment should be used routinely in patients undergoing PCI, irrespective of clinical presentation and chronic statin therapy; guideline committees should consider updates to incorporate this novel strategy for peri-PCI prevention of ischemic events.”

Source: Patti G, Cannon CP, Murphy SA, et al. 2011. Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention:  a collaborative patient-level meta-analysis of 13 randomized studies. Circulation 123:1622-1632