Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention

A collaborative patient-level meta-analysis of 13 randomized studies

Giuseppe Patti, Christopher P. Cannon, Sabina A. Murphy, Simona Mega, Vincenzo Pasceri, Carlo Briguori, Antonio Colombo, Kyeong Ho Yun, Myung Ho Jeong, Jung Sun Kim, Donghoon Choi, Huseyin Bozbas, Masayoshi Kinoshita, Keiichi Fukuda, Xin Wei Jia, Hidehiko Hara, Serkan Cay, Germano Di Sciascio

Research output: Contribution to journalArticle

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Abstract

Background-: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. Methods and results-: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase â‰1 3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). Conclusions-: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.

Original languageEnglish
Pages (from-to)1622-1632
Number of pages11
JournalCirculation
Volume123
Issue number15
DOIs
Publication statusPublished - 2011 Apr 19

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Percutaneous Coronary Intervention
Meta-Analysis
Myocardial Infarction
Risk Reduction Behavior
MB Form Creatine Kinase
C-Reactive Protein
Odds Ratio
Confidence Intervals
Control Groups

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Patti, Giuseppe ; Cannon, Christopher P. ; Murphy, Sabina A. ; Mega, Simona ; Pasceri, Vincenzo ; Briguori, Carlo ; Colombo, Antonio ; Yun, Kyeong Ho ; Jeong, Myung Ho ; Kim, Jung Sun ; Choi, Donghoon ; Bozbas, Huseyin ; Kinoshita, Masayoshi ; Fukuda, Keiichi ; Jia, Xin Wei ; Hara, Hidehiko ; Cay, Serkan ; Di Sciascio, Germano. / Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention : A collaborative patient-level meta-analysis of 13 randomized studies. In: Circulation. 2011 ; Vol. 123, No. 15. pp. 1622-1632.
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abstract = "Background-: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. Methods and results-: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase {\^a}‰1 3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0{\%} in the high-dose statin versus 11.9{\%} in the control group, which corresponds to a 44{\%} risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95{\%} confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4{\%} versus 12.6{\%}, a 44{\%} risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6{\%} versus 1.4{\%}; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68{\%} risk reduction for periprocedural myocardial infarction versus 31{\%} in those 1861 patients with normal CRP; P for quantitative interaction=0.025). Conclusions-: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.",
author = "Giuseppe Patti and Cannon, {Christopher P.} and Murphy, {Sabina A.} and Simona Mega and Vincenzo Pasceri and Carlo Briguori and Antonio Colombo and Yun, {Kyeong Ho} and Jeong, {Myung Ho} and Kim, {Jung Sun} and Donghoon Choi and Huseyin Bozbas and Masayoshi Kinoshita and Keiichi Fukuda and Jia, {Xin Wei} and Hidehiko Hara and Serkan Cay and {Di Sciascio}, Germano",
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Patti, G, Cannon, CP, Murphy, SA, Mega, S, Pasceri, V, Briguori, C, Colombo, A, Yun, KH, Jeong, MH, Kim, JS, Choi, D, Bozbas, H, Kinoshita, M, Fukuda, K, Jia, XW, Hara, H, Cay, S & Di Sciascio, G 2011, 'Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: A collaborative patient-level meta-analysis of 13 randomized studies', Circulation, vol. 123, no. 15, pp. 1622-1632. https://doi.org/10.1161/CIRCULATIONAHA.110.002451

Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention : A collaborative patient-level meta-analysis of 13 randomized studies. / Patti, Giuseppe; Cannon, Christopher P.; Murphy, Sabina A.; Mega, Simona; Pasceri, Vincenzo; Briguori, Carlo; Colombo, Antonio; Yun, Kyeong Ho; Jeong, Myung Ho; Kim, Jung Sun; Choi, Donghoon; Bozbas, Huseyin; Kinoshita, Masayoshi; Fukuda, Keiichi; Jia, Xin Wei; Hara, Hidehiko; Cay, Serkan; Di Sciascio, Germano.

In: Circulation, Vol. 123, No. 15, 19.04.2011, p. 1622-1632.

Research output: Contribution to journalArticle

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T1 - Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention

T2 - A collaborative patient-level meta-analysis of 13 randomized studies

AU - Patti, Giuseppe

AU - Cannon, Christopher P.

AU - Murphy, Sabina A.

AU - Mega, Simona

AU - Pasceri, Vincenzo

AU - Briguori, Carlo

AU - Colombo, Antonio

AU - Yun, Kyeong Ho

AU - Jeong, Myung Ho

AU - Kim, Jung Sun

AU - Choi, Donghoon

AU - Bozbas, Huseyin

AU - Kinoshita, Masayoshi

AU - Fukuda, Keiichi

AU - Jia, Xin Wei

AU - Hara, Hidehiko

AU - Cay, Serkan

AU - Di Sciascio, Germano

PY - 2011/4/19

Y1 - 2011/4/19

N2 - Background-: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. Methods and results-: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase â‰1 3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). Conclusions-: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.

AB - Background-: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. Methods and results-: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase â‰1 3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). Conclusions-: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.

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