title: A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes.
abstract: OBJECTIVE
  We assessed whether short-term, pre-procedural, intensive statin treatment may reduce contrast-induced acute kidney injury (CI-AKI) incidence in patients with and without acute coronary syndromes (ACS) undergoing coronary angiography (CA) and percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Statins may exert renal-protective effects through their pleiotropic properties. However, there have been conflicting reports on the CI-AKI preventive effect of pre-procedural statin administration.
  
  
  METHODS
  Randomized controlled trials published between January 1st, 2003 and February 28th, 2014 comparing the preventive effects against CI-AKI of pre-procedural statins vs. control (lower statin dose, no statin, or placebo) in patients undergoing CA/PCI were included.
  
  
  RESULTS
  Data were combined from 9 clinical trials enrolling 5212 patients (age 65 ± 5 years, 63% males). Pooled analysis showed that intensive, short-term statin pre-treatment significantly reduced the risk of CI-AKI as compared to control (relative risk [RR] 0.50; 95% confidence interval [CI] 0.39 to 0.64; P<0.001). Pre-specified subgroup analysis showed that intensive statin pre-treatment significantly reduced CI-AKI risk in patients with ACS (RR 0.37; 95% CI 0.25 to 0.55; P<0.0001), with only a non-significant positive trend in patients without ACS (RR 0.65; 95% CI 0.41 to 1.03; P=0.07). No evidence of publication bias was detected.
  
  
  CONCLUSIONS
  Short-term, pre-procedural, intensive statin treatment significantly reduced CI-AKI incidence in ACS patients, and may contribute to the overall clinical benefit associated with the early use of these drugs in this clinical setting. Its role in non-ACS patients warrants further investigation.
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan. Electronic address: giancarlo.marenzi@ccfm.it.
authors: Giancarlo
authors: G
authors: Marenzi
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan.
authors: Nicola
authors: N
authors: Cosentino
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan.
authors: José P
authors: JP
authors: Werba
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan.
authors: Calogero C
authors: CC
authors: Tedesco
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan.
authors: Fabrizio
authors: F
authors: Veglia
authors: Centro Cardiologico Monzino, I.R.C.C.S., Milan; University of Milan, Italy.
authors: Antonio L
authors: AL
authors: Bartorelli
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute coronary syndromes; Contrast-induced acute kidney injury; Coronary angiography; Percutaneous coronary intervention; Statins