Publications (2)14.74 Total impact
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Article: Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies.
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ABSTRACT: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.Circulation 04/2011; 123(15):1622-32. · 14.74 Impact Factor -
Article: Preprocedural statin therapy to prevent myocardial damage in percutaneous coronary intervention: a review of randomized trials.
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ABSTRACT: Multiple landmark clinical trials have demonstrated the beneficial effects of statin therapy for primary and secondary prevention of cardiovascular disease, but the exact timing of how early to treat relative to acute presentation has been less clear. The benefits of statin in cardiovascular disease can be explained not only by their lipid-lowering potential but also by non-lipid-related mechanisms, called pleiotropic effects. Percutaneous coronary intervention (PCI) can result in myocardial injury that is reflected by an increase in creatine kinase-MB and troponin I isoenzymes with worsened long-term prognosis following PCI. Observational studies suggested that pretreatment with statins might reduce the incidence of myocardial infarction after coronary intervention and prevent myocardial injury. Thus, several randomized controlled trials were conducted. They showed that pretreatment with statin before elective PCI reduces periprocedural myocardial injury in patients with stable angina. Moreover, short-term high-dose statin administration before coronary procedures also improves clinical outcome in patients with acute coronary syndromes and/or high preprocedural C-reactive protein levels. Thus, this evidence strongly supports routine utilization of high-dose statins as adjuvant pharmacological therapy before percutaneous coronary revascularization.Critical pathways in cardiology 03/2010; 9(1):19-22.
