title: Efficacy of short-term high-dose atorvastatin pretreatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a meta-analysis of nine randomized controlled trials.
abstract: BACKGROUND
  The efficacy of short-term high-dose atorvastatin pretreatment in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remains unclear. This meta-analysis was undertaken to assess the efficacy of short-term high-dose atorvastatin pretreatment in patients with ACS undergoing PCI.
  
  
  OBJECTIVE
  Short-term high-dose atorvastatin pretreatment may be beneficial in reducing major adverse cardiac events (MACEs) and improving myocardial blood flow in patients with ACS undergoing PCI.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically reviewed for randomized controlled trials (RCTs) published up to March 2013, in which short-term high-dose atorvastatin pretreatment was compared with control for patients with ACS undergoing PCI. The primary outcome measure was the incidence of MACEs at 30 days. The meta-analysis was performed with the fixed effect model or random-effects model according to the heterogeneity. Meta-analysis was performed by RevMan 5.0 software (Cochrane Collaboration, Copenhagen, Denmark).
  
  
  RESULTS
  Nine RCTs incorporating 952 patients met the inclusion criteria and were included in this meta-analysis. Short-term high-dose atorvastatin pretreatment significantly reduced the incidence of MACEs at 30-day follow-up (risk ratio [RR] 0.39, 95% confidence interval [Cl]: 0.25 to 0.61, P < 0.001) and improved the final Thrombolysis in Myocardial Infarction (TIMI) flow grade (RR 1.08, 95% Cl: 1.02 to 1.14, P = 0.01) compared with controls. There were no significant differences in peak creatine kinase-myocardial band and high-sensitivity C-reactive protein level post-PCI between the 2 groups, though there were favorable trends related to statin use. As to the safety end points, no significant difference was observed in elevated liver aminotransferase level between short-term high-dose atorvastatin pretreatment and control groups (RR 1.36, 95% Cl: 0.67 to 2.74).
  
  
  CONCLUSIONS
  The use of short-term high-dose atorvastatin pretreatment is safe and significantly improves the final TIMI flow grade as well as reduces the 30-day MACEs in ACS patients post-PCI. This finding encourages the use of short-term high-dose atorvastatin pretreatment as an alternative for ACS patients undergoing PCI, but more high-quality randomized clinical trials are still needed to confirm the long-term efficacy and safety.
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, China.
authors.forename: Yangchun
authors.initials: Y
authors.lastname: Liu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Su
authors.forename: Lang
authors.initials: L
authors.lastname: Li
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D003326:Coronary Circulation / Q000187:drug effects; D004334:Drug Administration Schedule; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
references.citation: Curr Med Res Opin. 2012 Jun;28(6):871-6
references.pmid: 22509860
references.citation: Thromb Haemost. 2000 May;83(5):688-92
references.pmid: 10823263
references.citation: Drugs. 2007;67 Suppl 1:29-42
references.pmid: 17910519
references.citation: Eur Heart J. 2002 Jun;23(11):869-76
references.pmid: 12042008
references.citation: Catheter Cardiovasc Interv. 2012 Nov 1;80(5):756-65
references.pmid: 22419603
references.citation: Circulation. 2008 Jun 17;117(24):3152-6
references.pmid: 18559715
references.citation: Clin Ther. 2013 Mar;35(3):261-72
references.pmid: 23410871
references.citation: G Ital Cardiol (Rome). 2012 Mar;13(3):171-228
references.pmid: 22395108
references.citation: Am J Med. 2004 Oct 15;117(8):596-606
references.pmid: 15465509
references.citation: Eur J Cardiothorac Surg. 2012 May;41(5):983-5
references.pmid: 22368186
references.citation: Am J Physiol Heart Circ Physiol. 2007 Sep;293(3):H1918-28
references.pmid: 17616749
references.citation: Catheter Cardiovasc Interv. 2008 Dec 1;72(7):950-7
references.pmid: 19021281
references.citation: Circulation. 2002 Sep 3;106(10):1205-10
references.pmid: 12208794
references.citation: Exp Mol Med. 2002 Dec 31;34(6):451-61
references.pmid: 12526087
references.citation: J Am Coll Cardiol. 2009 Jul 21;54(4):293-302
references.pmid: 19608026
references.citation: Int J Cardiol. 2012 Jun 28;158(1):93-100
references.pmid: 21295870
references.citation: JACC Cardiovasc Interv. 2010 Mar;3(3):332-9
references.pmid: 20298994
references.citation: J Am Coll Cardiol. 2007 Mar 27;49(12):1272-8
references.pmid: 17394957
references.citation: Lancet. 2005 Oct 8;366(9493):1267-78
references.pmid: 16214597
references.citation: Chin Med J (Engl). 2009 Mar 20;122(6):659-64
references.pmid: 19323930
references.citation: Circulation. 2009 Nov 3;120(18):1822-36
references.pmid: 19884481
references.citation: JAMA. 1998 May 27;279(20):1643-50
references.pmid: 9613915
references.citation: Expert Opin Pharmacother. 2005 Jun;6(6):915-27
references.pmid: 15952920
references.citation: Arterioscler Thromb Vasc Biol. 2002 Oct 1;22(10):1524-34
references.pmid: 12377727
references.citation: Heart. 2010 May;96(10):736-40
references.pmid: 20448123
references.citation: Am J Cardiol. 2007 Sep 15;100(6):919-23
references.pmid: 17826370
references.citation: Eur Heart J. 2011 Dec;32(23):2999-3054
references.pmid: 21873419
references.citation: Arterioscler Thromb Vasc Biol. 2002 Oct 1;22(10):1567-72
references.pmid: 12377731
references.citation: Curr Vasc Pharmacol. 2006 Apr;4(2):95-100
references.pmid: 16611152
references.citation: Eur Heart J. 2006 Mar;27(5):534-9
references.pmid: 16401674
references.citation: Ther Adv Cardiovasc Dis. 2012 Jun;6(3):101-14
references.pmid: 22562999
references.citation: Am Heart J. 2003 Jan;145(1):42-6
references.pmid: 12514653
references.citation: Am Heart J. 2011 Dec;162(6):1026-33
references.pmid: 22137076
references.citation: Atheroscler Suppl. 2004 Oct;5(3):81-7
references.pmid: 15531279
references.citation: Circulation. 2002 Apr 16;105(15):1756-9
references.pmid: 11956113
references.citation: Am J Cardiovasc Drugs. 2010;10 Suppl 1:3-9
references.pmid: 21391728
references.citation: Stroke. 2000 Oct;31(10):2442-9
references.pmid: 11022078
references.citation: J Am Coll Cardiol. 2010 Apr 20;55(16):1649-60
references.pmid: 20394867
references.citation: Atherosclerosis. 2009 Feb;202(2):491-7
references.pmid: 18572175
references.citation: Coron Artery Dis. 2011 Mar;22(1):87-91
references.pmid: 21169815
references.citation: J Am Coll Cardiol. 2011 Mar 8;57(10):1190-9
references.pmid: 21371635
references.citation: Eur Heart J. 2008 Jun;29(12):1578-90
references.pmid: 18456710
references.citation: Circulation. 1996 Oct 1;94(7):1528-36
references.pmid: 8840840
references.citation: J Am Coll Cardiol. 2003 Oct 15;42(8):1406-11
references.pmid: 14563583