Abstract
BackgroundNumerous studies have evidenced that statins can reduce the incidence of cardiovascular disease. However, the effects of high-dose rosuvastatin (RSV) preloading in patients undergoing percutaneous coronary intervention (PCI) are controversial.ObjectiveWe attempted to identify and quantify the potential cardioprotective benefits of high-dose RSV preloading on final thrombolysis in myocardial infarction (TIMI) flow grade, major adverse cardiac events (MACE), and peri-procedural myocardial injury (PMI) in patients undergoing PCI.MethodsPubmed, EMBASE, Cochrane Central Register of Controlled Trials and ISI Web of Science databases were systematically searched for randomized controlled trials (RCTs) up to June 2015. We assessed the incidence of MACE and PMI in all enrolled patients for subgroups stratified by clinical presentation and previous statin therapy during the follow-up period.ResultsFourteen trials with 3368 individuals were included in our meta-analysis. High-dose RSV preloading before PCI lead to a 58 % reduction in MACE (odds ratio [OR] = 0.42, 95 % confidence intervals [CI]: 0.29-0.61, P < 0.00001) and a 60 % reduction in PMI (OR = 0.40, 95 % CI: 0.25–0.63, P < 0.0001). This procedure also improved the final TIMI flow grade in patients undergoing PCI (OR = 1.61, 95 % CI: 1.09–2.38, P = 0.02). The benefits on MACE were significant for both stable angina patients (OR = 0.42, 95 % CI: 0.21-0.87, P = 0.02) and acute coronary syndrome (ACS) patients (OR = 0.42, 95 % CI: 0.27-0.65, P < 0.0001); and for both statin naïve patients (OR = 0.42, 95 % CI: 0.28-0.64, P < 0.0001) and previous statin therapy patients (OR = 0.28, 95 % CI: 0.10-0.73, P = 0.01).ConclusionHigh-dose RSV preloading can significantly improve myocardial perfusion and reduce both MACE and PMI in patients undergoing PCI. The cardioprotective benefits of RSV preloading were significant in not only stable angina and ACS patients but also statin naïve and previous statin therapy patients. The cardioprotective benefits of RSV preloading in the follow-up period mainly resulted from a reduction in spontaneous MI and TVR, especially for ACS and statin naïve patients.
Highlights
Percutaneous coronary intervention (PCI) is extensively used as a reperfusion strategy for coronary artery disease
The cardioprotective benefits of RSV preloading in the follow-up period mainly resulted from a reduction in spontaneous myocardial infarction (MI) and target vessel revascularization (TVR), especially for acute coronary syndrome (ACS) and statin naïve patients
Research previously focused on the improvement of antithrombotic agents and vasodilators in decreasing the incidence of cardiac ischemic events during percutaneous coronary intervention (PCI), while recently it was found that pretreatment with statins may significantly reduce major adverse cardiac events (MACE) and procedural myocardial injury (PMI) in patients undergoing PCI [3, 4]
Summary
Percutaneous coronary intervention (PCI) is extensively used as a reperfusion strategy for coronary artery disease. Research previously focused on the improvement of antithrombotic agents and vasodilators in decreasing the incidence of cardiac ischemic events during PCI, while recently it was found that pretreatment with statins may significantly reduce major adverse cardiac events (MACE) and PMI in patients undergoing PCI [3, 4]. It has already been proved in some metaanalyses of randomized controlled trials (RCTs) [5, 6]. The effects of high-dose rosuvastatin (RSV) preloading in patients undergoing percutaneous coronary intervention (PCI) are controversial
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