Meta-analysis of the role of statin therapy in reducing myocardial infarction following elective percutaneous coronary intervention.
Statin medications initiated during percutaneous coronary intervention have been evaluated in clinical trials mainly to assess if this therapy reduces subsequent restenosis. The benefit of statin therapy on individual cardiovascular outcomes other than restenosis is largely unknown. Hence, a meta-analysis of the available randomized trials was conducted to evaluate individual cardiovascular outcomes with statin therapy compared with placebo after elective percutaneous coronary intervention. In all, there were 6 studies available for analysis (Prevention of Restenosis by Elisor After Transluminal Coronary Angioplasty [PREDICT], Fluvastatin Angioplasty Restenosis [FLARE], the Lescol Intervention Prevention Study [LIPS], German Atorvastatin Intravascular Ultrasound [GAIN], Atorvastatin for Reduction of Myocardial Damage During Angioplasty [ARMYDA], and a study by Briguori et al) that randomized 3,941 patients (1,967 to statins and 1,974 to placebos). Clinical follow-up ranged from 1 day to 45 months. The incidence of myocardial infarction was 3.0% in the statin group and 5.2% in the placebo group (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.42 to 0.78, p<0.0001). The incidence of all-cause mortality was 2.3% versus 3.0% (OR 0.74, 95% CI 0.50 to 1.1, p=0.14), that of cardiovascular mortality was 0.71% versus 1.2% (OR 0.58, 95% CI 0.30 to 1.11, p=0.10), and that of repeat surgical or percutaneous revascularization was 19.6% versus 21.9% (OR 0.89, 95% CI 0.78 to 1.02, p=0.098) in the statin arm versus the placebo arm, respectively. The incidence of stroke was 0.4% in the statin arm and 0.08% in the placebo arm (OR 3.00, 95% CI 0.60 to 14.77, p=0.18). In conclusion, statin therapy initiated at the time of elective percutaneous coronary intervention significantly reduces myocardial infarction.
Mood
Girish R
GR
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Bavry
Anthony A
AA
Roukoz
Henri
H
Bhatt
Deepak L
DL
D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic