title: Preprocedural statin use in patients undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is.
  
  
  METHODS
  We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data.
  
  
  RESULTS
  Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P = .98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P = .11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P = .96).
  
  
  CONCLUSIONS
  A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI.
authors: Mohamad
authors: M
authors: Kenaan
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI.
authors: Milan
authors: M
authors: Seth
authors: Michigan Heart and Vascular Institute, St Joseph Mercy Hospital, Ann Arbor, MI.
authors: Herbert D
authors: HD
authors: Aronow
authors: Department of internal Medicine, Division of Cardiology, Henry Ford Health Systems, Mt Clemens, MI.
authors: Joseph
authors: J
authors: Naoum
authors: Department of Cardiology, Bronson Heart Care, Kalamazoo, MI.
authors: Douglas
authors: D
authors: Wunderly
authors: Michigan's Quality improvement Organization, Farmington Hills, MI.
authors: James
authors: J
authors: Mitchiner
authors: Department of internal Medicine, Division of Cardiovascular Medicine, University of Miami Health System, Miami, FL.
authors: Mauro
authors: M
authors: Moscucci
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI. Electronic address: hgurm@med.umich.edu.
authors: Hitinder S
authors: HS
authors: Gurm
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011300:Preoperative Care / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors