title: Effect of High-Dose Statin Pretreatment on the Incidence of Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention: Grading the Evidence Through a Cumulative Meta-analysis.
abstract: BACKGROUND
  Previous studies have showed that high-dose statin pretreatment could reduce the incidence of periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI). However, previous analyses have not performed reliable grading of evidence.
  
  
  OBJECTIVE
  In previous analyses, it supposed that the high-dose statin pretreatment was effective in reduction of the rate of PMI. In this analysis, we evaluated the effect of high-dose statin pretreatment on the reduction of rate of PMI based on a cumulative meta-analysis and grading of evidence.
  
  
  METHODS
  We assembled the relevant published randomized controlled trials that compared the efficacy of high-dose statin pretreatment prior to PCI. We evaluated the risk of PMI by a cumulative meta-analysis, with subgroups stratified by clinical classifications and different statin histories, and we conducted explicit grading of evidence.
  
  
  RESULTS
  High-dose statin pretreatment caused a 55% reduction in PMI through this cumulative meta-analysis of 23 RCTs (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.37-0.54). The effect of high-dose statin pretreatment was significant for the stable angina subgroup (OR: 0.42, 95% CI: 0.32-0.56), ACS subgroup (OR: 0.43, 95% CI: 0.29-0.64), and the mixed presentation subgroup (OR: 0.50, 95% CI: 0.36-0.70). In different statin therapy histories, high-dose statin pretreatment reduced incidence of PMI 55% in the statin-naive subgroup (OR: 0.45, 95% CI: 0.36-0.56) and 54% in the low-dose statin subgroup (OR: 0.46, 95% CI: 0.32-0.66). The GRADE system indicated that the overall evidence quality was moderate. This finding may strengthen the confidence in any recommendations.
  
  
  CONCLUSIONS
  High-dose statin pretreatment can reduce the rate of PMI, irrespective of either the clinical presentation or previous statin-treatment history. Importantly, the overall GRADE evidence quality was moderate.
authors.affiliation: Graduate School, Tianjin Medical University, Tianjin, China.|Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.|Department of Cardiology, Tianjin Gongan Hospital, Tianjin, China.
authors.forename: ChuanNan
authors.initials: C
authors.lastname: Zhai
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
authors.forename: HongLiang
authors.initials: H
authors.lastname: Cong
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
authors.forename: YuJie
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Graduate School, Tianjin Medical University, Tianjin, China.
authors.forename: XianFeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Graduate School, Tianjin Medical University, Tianjin, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Graduate School, Tianjin Medical University, Tianjin, China.
authors.forename: ZhiJing
authors.initials: Z
authors.lastname: Ren
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; 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; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors