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

Please note that this article has been retracted by the European Heart Journal.

For more information, click here .

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.


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.


1. Yun KH, Shin I-S, Shin S-N, Choi J-H, Kim SH, Rhee SJ, Lee EM, Yoo NJ, Kim N-H, Oh SK, Jeong J-W. Effect of previous statin therapy in patients with acute coronary syndrome and percutaneous coronary intervention. Korean Circ J 2011;41:458–463.

2. Sacks FM. Do statins play a role in the early management of the acute coronary syndrome? Eur Heart J Suppl 2004;6(Suppl_A):A32–A36.

3. Khera AV, Qamar A, Murphy SA, Cannon CP, Sabatine MS, Rader DJ. On-statin resistin, leptin, and risk of recurrent coronary events after hospitalization for an acute coronary syndrome (from the pravastatin or atorvastatin evaluation and infection therapy-thrombolysis in myocardial infarction 22 study). Am J Cardiol 2015;116:694–698.

4. Ozaydin M, Turker Y, Erdogan D, Karabacak M, Dogan A, Varol E, Gonul E, Altinbas A. The association between previous statin use and development of atrial fibrillation in patients presenting with acute coronary syndrome. Int J Cardiol 2010;141:147–150.

5. Wang CY, Liu PY, Liao JK. Pleiotropic effects of statin therapy: molecular mechanisms and clinical results. Trends Mol Med 2008;14:37–44.

6. Nusca A, Melfi R, Patti G, Di SG. Atorvastatin for reduction of myocardial damage during angioplasty trials. J Cardiovasc Med 2010;11:709–711.

7. Patti G, Pasceri V, Colonna G, Miglionico M, Fischetti D, Sardella G, Montinaro A, Di SG. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial. J Am Coll Cardiol 2007;49: 1272–1278.

8. Briguori C, Visconti G, Focaccio A, Golia B, Chieffo A, Castelli A, Mussardo M, Montorfano M, Ricciardelli B, Colombo A. Novel approaches for preventing or limiting events (Naples) II trial: impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol 2009;54: 2164–2166.

9. Winchester DE, Wen X, Xie L, Bavry AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 2010;56: 1099–1109.

Find this article online at Eur Heart J Read about the retraction of this article

Facebook Comments


We’re glad to see you’re enjoying PACE-CME…
but how about a more personalized experience?

Register for free