title: High dose statin loading prior to percutaneous coronary intervention decreases cardiovascular events: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We performed a meta-analysis of randomized controlled trials of statin loading prior to percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Statin loading prior to PCI has been shown to decrease peri-procedural myocardial infarction (pMI) but less is known regarding the clinical benefit of pre-procedural statin loading.
  
  
  METHODS
  We searched for trials of statin naïve patients presenting with stable angina or NSTE-ACS and treated with statins prior to PCI. We evaluated the incidence of pMI and major cardiac events including spontaneous myocardial infarction, death, and target vessel revascularization.
  
  
  RESULTS
  Out of 1,210 articles, 14 randomized controlled trials were included in this meta-analysis. Among 3,146 patients, 1,591 patients were randomized to a loading dose of statin before PCI and 1,555 patients were given statin therapy initiated only after the PCI. Statin loading prior to PCI was associated with a 56% relative reduction in pMI (OR: 0.44, 95% CI: 0.35-0.56; P < 0.00001). There was a 41% reduction in clinical events in follow-up in the group of patients treated with statin loading prior to PCI (OR: 0.59, 95% CI: 0.38-0.92, P = 0.02). When stratified according to the clinical presentation, the results were only significant for those patients with NSTE-ACS (OR: 0.18, 95% CI: 0.07-0.47; P = 0.0005) and was not noted in the group of patients who underwent PCI for stable angina (OR: 0.92, 95% CI: 0.53-1.61; P = 0.78).
  
  
  CONCLUSIONS
  High dose statin therapy given prior to PCI in patients with NSTE-ACS is associated with a reduction in pMI and short-term clinical events. © 2013 Wiley Periodicals, Inc.
authors.affiliation: St. Luke's and Roosevelt Hospitals and Columbia University, College of Physicians and Surgeons, New York, New York; Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Benjo
authors.forename: Georges E
authors.initials: GE
authors.lastname: El-Hayek
authors.forename: Franz
authors.initials: F
authors.lastname: Messerli
authors.forename: James J
authors.initials: JJ
authors.lastname: DiNicolantonio
authors.forename: Mun K
authors.initials: MK
authors.lastname: Hong
authors.forename: Emad F
authors.initials: EF
authors.lastname: Aziz
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tamis-Holland
mesh_terms: D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D065840:Protective Factors; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: clinical events; non ST-elevation acute coronary syndrome; periprocedural myocardial infarction