title: Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: A systematic review and trial sequential analysis.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is a potential complication in coronary angiography (CAG) and percutaneous coronary interventions (PCI). Prior randomized controlled trials (RCTs) have suggested that statins may play a role in reducing rates of CI-AKI, however it is not clear how firm the current evidence is.
  
  
  OBJECTIVE
  The aim of this study was to conduct a meta-analysis and trial sequential analysis to determine the effects of statins in lowering CI-AKI rates in CAG and PCI.
  
  
  METHODS
  A systematic literature search was performed to include all RCTs comparing statins (treatment arm) versus low-dose statins or placebo (control arm) as pretreatment for CAG and/or PCI. A traditional meta-analysis and several subgroup analyses were conducted using traditional meta-analysis with relative risk (RR), trial sequential analysis, and meta-regression analysis.
  
  
  RESULTS
  14 RCTs met our inclusion criteria giving a total of 2992 statin treated (49.6%) and 3041 control patients (50.4%). There was a significant reduction in CI-AKI in the statin group compared to controls (3.7% vs 8.3%, RR, 0.46; p=<0.00001). Trial sequential analysis using a relative risk reduction threshold of 20%, power 80% and type 1 error of 5%, indicated that the evidence is firm. A greater risk reduction in CI-AKI in the statin group significantly correlated with higher estimated glomerular filtration rate (eGFR; p=0.003) CONCLUSIONS: The present trial sequential analysis provides support for statins in reducing the incidence of CI-AKI in patients undergoing CAG/PCI. This effect appeared to be greater in patients with higher eGFR.
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Westmead Hospital, Sydney, Australia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Qian
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia. Electronic address: kphan.vc@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D015994:Incidence; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D059035:Perioperative Period; D016032:Randomized Controlled Trials as Topic
chemical_list: D003287:Contrast Media; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute kidney injury; Angioplasty; Contrast; Meta-analysis; Percutaneous coronary intervention; Trial sequential analysis