Reduced CV events with loading dose of statin before PCI in patients with ACS

Short-term and long-term effects of a loading dose of atorvastatin before percutaneous coronary intervention on major adverse cardiovascular events in patients with acute coronary syndrome: a meta-analysis of 13 randomized controlled trials

Literature - Ye Z, Lu H, Su Q et al. - Eur Heart J 2019;0,1-10

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Introduction and methods

Although a loading dose of statin can significantly reduce the incidence of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), especially the incidence of myocardial infarction (MI) [1-9], it remains unclear whether a loading dose of atorvastatin can reduce the incidence of MACE in patients with acute coronary syndrome (ACS) after PCI. This meta-analysis (n=22.095) therefore estimated the effects of a loading dose of atorvastatin (80 mg) (50.7%) vs. conventional therapy (49.3%) before PCI on MACE in patients with ACS.

Inclusions criteria were as follows: diagnosis of ACS, randomized controlled trial, loading dose of atorvastatin was 80 mg before a planned PCI, control group received conventional therapy, and sufficient data available for analysis. Primary endpoints were all-cause mortality and MACE (composite of non-fatal MI, rehospitalization, revascularization, and stroke). In total 13 trials were included and for subanalysis divided into two groups based on the time of follow-up: short-term (≤30 days)(7 studies) and long-term (>30 days)(3 studies).

Main results

Atorvastatin 80 mg reduced risk for MACE, compared with conventional therapy (RR: 0.66, 95%CI: 0.54–0.80, I²= 72.0%), both on short-term (RR: 0.57, 95%CI: 0.39–0.85, I²= 63.9%) and long-term (RR: 0.70, 95%CI: 0.55–0.89, I²= 83.7%).
Incidence of non-fatal MI was significantly reduced with atorvastatin 80 mg, compared with conventional therapy (RR: 0.61, 95%CI: 0.46–0.80, I²= 63.2%), both on short-term (RR: 0.61, 95%CI: 0.42–0.89, I²= 37.8%) and long-term (RR: 0.58, 95%CI: 0.36–0.95, I²= 81.5%).
In the atorvastatin group, significantly reduced incidence of revascularization was observed, compared with conventional therapy (RR: 0.76, 95%CI: 0.69–0.83, I²= 0.0%). This effect was only observed on long-term (RR: 0.76, 95%CI: 0.69–0.84, I²= 0.0%).
Atorvastatin 80 mg significantly reduced the incidence of stroke, compared with conventional therapy (RR: 0.69, 95%CI: 0.49–0.96, I²= 16.0%), without significant differences between short-term and long-term follow-up.
No significant difference was observed in rehospitalization between atorvastatin 80 mg and conventional therapy (RR: 0.64, 95%CI: 0.39–1.04, I²= 34.2%).
The effect of atorvastatin 80 mg on all-cause mortality did not significantly differ from conventional therapy (RR: 0.84, 95%CI: 0.64–1.10, I²= 37.5%), neither on short-term nor on long-term.

Conclusion

This meta-analysis of 13 randomized controlled trials showed that a loading dose of atorvastatin (80 mg) before PCI markedly reduced MACE (non-fatal MI, rehospitalization, revascularization, and stroke) in patients with ACS.

References

Show references

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