title: Meta-analysis of time-related benefits of statin therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
abstract: Patients with acute coronary syndromes (ACSs) still experience high rates of recurrent coronary events, particularly, early in their presentation. Statins yield substantial cardiovascular benefits, but the optimal timing of their administration, before or after percutaneous coronary intervention (PCI), remains unclear. We aimed to perform a meta-analysis of randomized controlled trials of statin administration before or after PCI versus no statin or low-dose statin in patients with ACS. Primary end points were 30-day all-cause mortality and 30-day myocardial infarction (MI) stratified by pre- and post-PCI statin administration. Secondary end points were major adverse cardiac events (MACEs) or major adverse cardiac and cerebrovascular events (MACCEs). Long-term analysis beyond 30 days was also performed. Twenty randomized controlled trials enrolling 8,750 patients were included. At 30 days, the rate of MI was significantly lower in the statin group (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.53 to 0.84, p = 0.0007) with a trend toward reduced mortality (p = 0.06) and significant reductions in MACE and MACCE compared with no or low-dose statin. The 30-day incidence of MI was markedly lower when statins were administered before PCI (OR 0.38, 95% CI 0.24 to 0.59, p <0.0001) rather than after PCI (p = 0.28). The direction and magnitude of the estimates for before and after PCI versus no statin or low-dose statin were sustained at long term, not reaching statistical significance for MI (OR 0.81, 95% CI 0.65 to 1.01, p = 0.06) but with significant reductions in MACE (p = 0.0002). By meta-regression, earlier statin administration correlated significantly with lower risk of MI, MACE, and MACCE at 30 days. In conclusion, the present meta-analysis indicates a time-related impact of statin therapy on clinical outcomes of patients with ACS undergoing PCI: the earlier the administration before PCI, the greater the benefits.
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus Univeristy, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network. Electronic address: eliano.navarese@alice.it.
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.affiliation: Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network; 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: van Wely
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Cyril
authors.initials: C
authors.lastname: Camaro
authors.affiliation: Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus Univeristy, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network.
authors.forename: Michalina
authors.initials: M
authors.lastname: Kolodziejczak
authors.affiliation: Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network; 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Gorny
authors.affiliation: Cardiovascular Center Cinere, Jakarta, Indonesia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wirianta
authors.affiliation: Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus Univeristy, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D011300:Preoperative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors