Abstract
ObjectivesWe prospectively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).MethodsWe enrolled 1078 consecutive patients with CKD undergoing elective PCI. Patients in Group 1 (n = 273) received rosuvastatin (10 mg), and those in group 2 (n = 805) received atorvastatin (20 mg). The primary end-point was the development of CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL, or an increase ≥25% from baseline within 48–72 h after contrast medium exposure.ResultsCIN was observed in 58 (5.4%) patients. The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin (5.9% vs. 5.2%, p = 0.684). The same results were also observed when using other definitions of CIN. Clinical and procedural characteristics did not show significant differences between the two groups (p>0.05). Additionally, there were no significant inter-group differences with respect to in-hospital mortality rates (0.4% vs. 1.5%, p = 0.141), or other in-hospital complications. Multivariate logistic regression analysis revealed that rosuvastatin and atorvastatin demonstrated similar efficacies for preventing CIN, after adjusting for potential confounding risk factors (odds ratio = 1.17, 95% confidence interval, 0.62–2.20, p = 0.623). A Kaplan–Meier survival analysis showed that patients taking either rosuvastatin or atorvastatin had similar incidences of all-cause mortality (9.4% vs. 7.1%, respectively; p = 0.290) and major adverse cardiovascular events (29.32% vs. 23.14%, respectively; p = 0.135) during follow-up.ConclusionsRosuvastatin and atorvastatin have similar efficacies for preventing CIN in patients with CKD undergoing PCI.
Highlights
Contrast-induced nephropathy (CIN) is an important and wellknown complication in patients undergoing percutaneous coronary intervention (PCI)
Kaya et al (ROSA-contrast-induced nephropathy (CIN) trial) conducted a study including 198 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI to determine if rosuvastatin and atorvastatin had similar efficacies for preventing CIN [15]
The inclusion criteria included: patients with an estimated glomerular filtration rate of 30–90 mL/min/1.73 m2 (CKD stages II and III), and patients pretreated with either atorvastatin (20 mg) or rosuvastatin (10 mg), at equivalent standard doses [16]
Summary
Contrast-induced nephropathy (CIN) is an important and wellknown complication in patients undergoing percutaneous coronary intervention (PCI). Statins belong to a drug class that has pleiotropic effects on the vasculature and improves endothelial function, probably by increasing nitric oxide synthetase bioavailability and decreasing oxidative stress [5,6,7] These properties counteract specific pathophysiologic mechanisms that promote the development of CIN [2,8]. Not all statins (especially, rosuvastatin and atorvastatin) are equivalent; they vary in several properties, including low-density lipoprotein (LDL) cholesterol lowering potency, lipophilicity, renoprotection, anti-inflammatory effects, and their effects on myocardial function [13,14]. Whether these differences significantly influence their effect on preventing CIN remains unknown.
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