title: Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy. g.patti@unicampus.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Patti
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Simona
authors.initials: S
authors.lastname: Mega
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Kyeong Ho
authors.initials: KH
authors.lastname: Yun
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Huseyin
authors.initials: H
authors.lastname: Bozbas
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Jia
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.forename: Serkan
authors.initials: S
authors.lastname: Cay
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
mesh_terms: D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors