Statin Pretreatment Research Articles

Effect of High Dose Statin Pretreatment on Endothelial Progenitor Cells After Percutaneous Coronary Intervention (HIPOCRATES Study).

Pretreatment with high-dose statins given before percutaneous coronary intervention (PCI) has been shown to have beneficial effects, in particular by reducing peri-procedural myocardial infarction. The mechanism of these lipid-independent beneficial statin effects is unclear. Circulating endothelial progenitor cells (EPCs) have an important role in the process of vascular repair, by promoting re-endothelization following injury. We hypothesized that statins can limit the extent of endothelial injury induced by PCI and promote re-endothelization by a positive effect on EPCs. We, therefore, aimed to examine the effect of high-dose statins given prior to PCI on EPCs profile. Included were patients, either statin naïve or treated chronically with low-dose statins, with stable or unstable angina who underwent PCI. Patients were randomized to receive either high-dose atorvastatin (80 mg the day before PCI and 40 mg 2-4 h before PCI) or low- dose statin. EPCs profile was examined before PCI and 24 h after it. Circulating EPCs levels were assessed by flow cytometry as the proportion of peripheral mononuclear cells co-expressing VEGFR-2+ CD133+ and VEGFR-2+ CD34+. The capacity of the cells to form colony forming units (CFUs) was quantified after 7 days of culture. Twenty three patients (mean age 61.4 ± 7.4 years, 87.0% men) were included in the study, of which 12 received high-dose atorvastatin prior to PCI. The mean number of EPC-CFUs before PCI was higher in patients treated with high-dose atorvastatin vs. low-dose statins (165.8 ± 58.8 vs. 111.7 ± 38.2 CFUs/plate, respectively, p < 0.001). However, 24 h after the PCI, the number of EPC-CFUs was similar (188.0 ± 85.3 vs. 192.9 ± 66.5 CFUs/plate in patients treated with high-dose atorvastatin vs. low- dose statins, respectively, p = 0.15). There were no statistical significant differences in FACS analyses between the 2 groups. The current study showed higher EPC- CFUs levels in patients treated with high-dose atorvastatin before PCI and a lower increment in EPC-CFUs after PCI. These findings could account for the beneficial effects of statins given prior to PCI, yet further investigation is required.

A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes

ObjectivesWe assessed whether short-term, pre-procedural, intensive statin treatment may reduce contrast-induced acute kidney injury (CI-AKI) incidence in patients with and without acute coronary syndromes (ACS) undergoing coronary angiography (CA) and percutaneous coronary intervention (PCI). BackgroundStatins may exert renal-protective effects through their pleiotropic properties. However, there have been conflicting reports on the CI-AKI preventive effect of pre-procedural statin administration. MethodsRandomized controlled trials published between January 1st, 2003 and February 28th, 2014 comparing the preventive effects against CI-AKI of pre-procedural statins vs. control (lower statin dose, no statin, or placebo) in patients undergoing CA/PCI were included. ResultsData were combined from 9 clinical trials enrolling 5212 patients (age 65±5years, 63% males). Pooled analysis showed that intensive, short-term statin pre-treatment significantly reduced the risk of CI-AKI as compared to control (relative risk [RR] 0.50; 95% confidence interval [CI] 0.39 to 0.64; P<0.001). Pre-specified subgroup analysis showed that intensive statin pre-treatment significantly reduced CI-AKI risk in patients with ACS (RR 0.37; 95% CI 0.25 to 0.55; P<0.0001), with only a non-significant positive trend in patients without ACS (RR 0.65; 95% CI 0.41 to 1.03; P=0.07). No evidence of publication bias was detected. ConclusionsShort-term, pre-procedural, intensive statin treatment significantly reduced CI-AKI incidence in ACS patients, and may contribute to the overall clinical benefit associated with the early use of these drugs in this clinical setting. Its role in non-ACS patients warrants further investigation.

High-dose statin pretreatment decreases periprocedural myocardial infarction and cardiovascular events in patients undergoing elective percutaneous coronary intervention: a meta-analysis of twenty-four randomized controlled trials.

BackgroundEvidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention.MethodsWe searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment.ResultsTwenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45–0.83; P = 0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P = 0.12). Long-term effects on survival were less obvious.ConclusionsHigh-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome.

Efficacy of short-term high-dose statin pretreatment in prevention of contrast-induced acute kidney injury: updated study-level meta-analysis of 13 randomized controlled trials.

BackgroundThere have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.Methods and ResultsRandomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2–5days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35–0.57, p<0.001, I2 = 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34–0.65, p<0.001, I2 = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21–0.58, p<0.001, I2 = 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥60years), regardless of osmolality of contrast or administration of N-acetylcystein.ConclusionsHigh-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

Effect of statins in preventing contrast-induced nephropathy: an updated meta-analysis.

The effect of statins in preventing contrast-induced nephropathy (CIN) has been reported, with conflicting results. The aim of this study was to carry out an updated meta-analysis to determine whether pretreatment with statins can reduce the risk of CIN and adverse clinical events. Systematic database searches of MEDLINE (1950 to December 2013), EMBASE (1966 to December 2013), and the Cochrane Central Register of Controlled Trials (Issue 12, December 2013) were performed. All randomized controlled trials assessing the efficacy of statins on CIN were included. Seventeen studies with 6323 patients were included. Pretreatment with statins before angiography significantly reduced the risk of CIN [relative risk 0.50; 95% confidence interval (CI) 0.35-0.71; P<0.001] and was associated with significantly lower postprocedural serum creatinine levels (weighted mean difference -0.05 mg/dl; 95% CI -0.09 to -0.02 mg/dl; P=0.005). Meanwhile, the use of statins resulted in trends of reduced risks of renal replacement therapy and all-cause death within 30 days (relative risk 0.44; 95% CI 0.18-1.08; P=0.07). Further analyses indicated that high-dose statins were more effective than low-dose statins in reducing the risk of CIN and that different types of statins showed similar effects in preventing CIN. Pretreatment with statins before angiography is effective in preventing CIN and may reduce the risk of adverse clinical events. However, the optimal dose and duration for statin pretreatment are still unknown.

GW25-e3466 The short-term effects of pre-treatment of statins on reperfusion and short-term clinical prognosis after percutaneous coronary intervention in patients with non ST-segment elevation acute coronary syndrome

To evaluate the effect of pre-treatment with statin on the reperfusion and short-term clinical prognosis in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent successful primary percutanous coronary intervention (PCI). A total of 162 consecutive high –risk

Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: A Meta-analysis of Randomized Controlled Trials.

Statins have been demonstrated to prevent the development of contrast-induced nephropathy (CIN). Nevertheless, clinical research has indicated conflicting results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effects of statins on CIN and the requirement of renal replacement therapy (RRT) in patients undergoing coronary angiography/percutaneous interventions. PubMed, MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central RCTs were searched for RCTs from inception to February 2014 to compare statins with placebo treatment for preventing CIN in patients undergoing coronary angiography/percutaneous interventions. Nine RCTs were identified and analyzed in a total of 5143 patients involving 2560 patients with statin pretreatment and 2583 patients as control. Patients who received statin therapy had a 53% lower risk of CIN with different definitions (within 48 or 72 hours) compared to the control group based on a fixed effect model (risk ratio = 0.47, 95% confidence interval = 0.37-0.60, P < .0001) and were less likely to require RRT based on Peto fixed effect. Subgroup analysis showed that statin pretreatment could decrease the incidence of CIN in patients with preexisting renal dysfunction or diabetes mellitus. In addition, patients on rosuvastatin had a similar reduced incidence of CIN compared to patients on atorvastatin. This updated meta-analysis demonstrated that preprocedural statin treatment could reduce the risk of CIN and the need for RRT in patients undergoing coronary angiography/percutaneous interventions. Moreover, statin therapy would be helpful in reducing the incidence of CIN in high-risk patients with preexisting renal dysfunction or diabetes mellitus. Additionally, rosuvastatin and atorvastatin had similar efficacies in preventing CIN development.

TCT-257 Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Nephropathy: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

TCT-257 Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Nephropathy: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

TCT-256 Benefit of Statin Pretreatment in Prevention of Contrast Induced Nephropathy: Systematic Review and Meta-analysis

TCT-256 Benefit of Statin Pretreatment in Prevention of Contrast Induced Nephropathy: Systematic Review and Meta-analysis

Benefit of statin pretreatment in prevention of contrast-induced nephropathy in different adult patient population: systematic review and meta-analysis

ObjectivePrevious studies have suggested that statin pretreatment prevents contrast-induced nephropathy (CIN). However, single randomised trials are limited in their number of patients. This meta-analysis aims to assess the role of...

Impact of Long-Term Statin Pretreatment on Myocardial Damage in ST Elevation Myocardial Infarction (from the AIDA STEMI CMR Substudy)

Nonrandomized studies suggested lower mortality rates with statin pretreatment in patients with acute ST elevation myocardial infarction (STEMI). However, clinical data are still inconclusive and the mechanisms of these presumed beneficial effects require further exploration. Cardiac magnetic resonance (CMR) imaging offers the possibility of studying a variety of markers of myocardial damage and reperfusion injury after myocardial infarction. The aim of this study was to assess a possible link of statin pretreatment with myocardial damage in acute STEMI. The multicenter Abciximab i.v. versus i.c. in ST-elevation Myocardial Infarction CMR substudy enrolled 795 consecutive patients with acute STEMI who underwent primary angioplasty within 12hours of symptom onset. CMR studies assessing left ventricular ejection fraction, infarct size, microvascular obstruction, area at risk, and myocardial salvage index were performed in a median of 3days after the clinical event. We performed a retrospective analysis to evaluate the impact of statin pretreatment on myocardial damage. Information on statin pretreatment was available in 791 of 795 patients (99%). Of these, 122 (15%) had long-term statin pretreatment. CMR results showed no significant differences in the area at risk, left ventricular ejection fraction, infarct size, microvascular obstruction, and myocardial salvage index between patients with and without statin pretreatment. Furthermore, no differences in short- and long-term outcomes could be observed. In conclusion, in this CMR study, statin pretreatment in patients with STEMI was not associated with lesser myocardial damage.

Impact of high-dose statin pre-treatment and contrast-induced acute kidney injury on follow-up events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality [1]. Randomized investigations showed that short-term pre-treatment with high-dose statins prior to coronary angiography or intervention reduces the incidence of CI-AKI, especially in the setting of acute coronary syndrome (ACS) [2,3]; pleiotropic effects may explain this benefit. To date, it is unknown whether renal protection provided by statins in such patients translates also into improvement of clinical outcome during long-term follow-up; in order to test such hypothesis, we have pooled individual follow-up data from the patients' population of two published randomized studies that have demonstrated a significant CI-AKI reduction by pre-treatment with high-dose statin (vs no statin pre-treatment) in statin-naïve patients undergoing early percutaneous coronary intervention (PCI) for non ST-segment elevation ACS [2,3].

Does statin pre-treatment affect right atrial myocyte apoptosis in coronary artery bypass graft patients? an in-vivo pilot study

Background: This study aims to investigate the possible protective effects of statin pretreatment against right atrial myocyte apoptosis in patients undergoing coronary artery bypass grafting. Methods: Twenty-nine consecutive patients were included in the study. Group 1 patients (n=12; male: 83.3%) were initiated on atorvastatin 40 mg/day on the day of hospital admission and group 2 patients (n=17; male: 82.3%) did not receive statin therapy. Right atrial samples were taken before cardiopulmonary bypass and fixed in 10% neutral formalin. Immunoperoxidase staining and TUNEL method were performed to detect apoptotic cells. The immunostained active caspase-3 and proliferating cell nuclear antigen (PCNA) cells were counted using a light microscope. Results: The mean apoptotic index was significantly lower in endocardial (p=0.04) and epicardial layers (p=0.01) of group 1 patients compared to those of group 2. Myocardial layer values were similar between the groups (p=0.35). The mean PCNA index in any layers was not significantly different between groups. Conclusion: Statin pretreatment before CABG seems to diminish cardiac myocyte loss, providing an explanation for their beneficial effects seen after open heart surgery.

Preprocedural statin use in patients undergoing percutaneous coronary intervention

Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is. We evaluated the incidence and in-hospital outcomes associated with statin pretreatment among patients undergoing PCI and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry at 44 hospitals in Michigan between January 2010 and December 2012. Propensity and exact matching were used to adjust for the nonrandom use of statins prior to PCI. Long-term mortality was assessed in a subset of patients who were linked to Medicare data. Our study population was comprised of 80,493 patients of whom 26,547 (33 %) did not receive statins prior to undergoing PCI. When compared to statin receivers, nonreceivers had lower rates of prior cardiovascular disease. In the matched analysis, absence of statin use prior to PCI was associated with a similar rate of in-hospital mortality (0.43% vs 0.42%, odds ratio 1.00, 95% CI 0.70-1.42, P = .98) and periprocedural myocardial infarction (2.34% vs 2.10%, odds ratio 1.13, 95% CI 0.97-1.32, P = .11) compared to statin receivers. Likewise, no difference in the rate of coronary artery bypass grafting, cerebrovascular accident (CVA), or contrast-induced nephropathy was observed. There was no association between pre-PCI use of statins and long-term survival among the subset of included Medicare patients (hazard ratio = 1.0, P = .96). A significant number of patients undergo PCI without statin pretreatment, but this is not associated with in-hospital major complications or long-term mortality.

Interleukin‐6, but Not C‐Reactive Protein, Predicts the Occurrence of Cardiovascular Events after Drug‐Eluting Stent for Unstable Angina

Evidences concerning the predictive value of baseline inflammatory biomarkers after drug-eluting stent (DES) placement are controversial, mainly because the use of statin was not precisely defined. The aim was to compare the differences between interleukin (IL)-6 and high-sensitivity C-reactive protein (hs-CRP) in predicting cardiovascular events 2 years after stenting in patients with unstable angina (UA) who had not received statin pretreatment. There were 1,896 patients included in this study. The primary end-point was the occurrence of cardiac death or myocardial infarction (MI). Secondary endpoints included all-cause death, stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), or a composite of major adverse cardiac events (MACE) at 2 years after the procedure. During the median follow-up of 2.77 years, 96 patients experienced cardiac death (n = 37, 1.95%) or MIs (n = 70, 3.69%), 94 TLRs, 123 TVRs, 215 MACEs, and 21 definite or probable STs. In multivariable Cox proportional-hazards models and discrimination analysis, elevated IL-6 levels were superior to hs-CRP in predicting the occurrence not only of cardiac death or MI (HR 1.337, 95% CI 1.234-1.449, P < 0.001), but also of MACE and late-occurring definite/probable ST. Incorporation of IL-6 into conventional variables resulted in significantly increased c statistic for the prediction of end-points, with the exception of TLR and TVR. Elevated IL-6 levels were independent predictors of cardiac death or MI, MACE, and late ST in patients with UA who had not received statin pretreatment, suggesting a role for IL-6 in the inflammatory risk assessment. Pathological studies have confirmed that atherosclerosis is a chronic inflammatory disease. Serum levels of high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase, plasminogen activator inhibitor-1, the complement components C3a or C5a, and interleukin(IL)-6 were reported to provide strong and independent indications of the risk for future cardiovascular (CV) events, even among individuals who are thought to be free of vascular disease.

Abstract 75: Safety of Statin Pretreatment in Intravenous Thrombolysis (IVT) for Acute Ischemic Stroke (AIS)

Background&amp;Purpose: A recent meta-analysis investigating the association between statin pretreatment and early outcomes in patients with AIS indicated that pre-stroke statin treatment was associated with increased risk of 90-day mortality and symptomatic intracranial hemorrhage (sICH). We sought to investigate the potential association of statin pretreatment with early outcomes in a large, international registry of AIS patients treated with IVT. Subjects&amp;Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke-East registry (SITS-EAST) on consecutive AIS patients treated with IVT during a seven-year period. We used three widely accepted definitions for sICH from NINDS-rtPA-Stroke Study, ECASS II trial and SITS registry. Dramatic clinical recovery (DCR) within 24 hours was defined as reduction in the baseline NIHSS-score of ≥10 points. Favorable functional outcome (FFO) at three months was defined as modified Rankin Scale score of 0-1. Results: We analyzed a total of 1660 AIS patients (mean age 67±13 years, median baseline NIHSS-score 11 points, interquartile range 5-16). Patients with statin pretreatment (n=373, 23%) had higher (p=0.019) baseline stroke severity compared to cases who had not received any statin at symptom onset. After adjusting for demographics, baseline stroke severity, onset-to-treatment time, history of previous stroke, risk factors, and admission blood pressure levels, statin pretreatment was not associated with a higher likelihood of sICH defined by the NINDS (OR: 1.41; 95%CI: 0.83-2.39; p=0.201), ECASS II (OR: 1.13; 95%CI: 0.60-2.14; p=0.712) or SITS (OR: 1.89; 95%CI: 0.75-4.77; p=0.178) criteria. Statin pretreatment was not related to three-month all-cause mortality (OR: 0.92; 95%CI: 0.57-1.49; p=0.741) or three-month FFO (OR: 0.81; 95%CI: 0.52-1.27; p=0.364). Statin pretreatment was independently associated with a higher odds of DCR (OR: 1.91; 95%CI: 1.25-2.92; p=0.003). Conclusions: Our findings indicate that statin therapy at symptom onset is not associated with adverse outcomes in AIS patients treated with IVT, while statin pretreatment almost doubles the likelihood of DCR during the first hours following tPA-infusion.

Reduction in Early Stroke Risk in Carotid Stenosis With Transient Ischemic Attack Associated With Statin Treatment

In patients with acute symptomatic carotid stenosis, statin pretreatment is associated with reduced stroke risk.

Effect of High Dose Rosuvastatin Loading before Primary Percutaneous Coronary Intervention on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction

Background and ObjectivesHigh dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting.Subjects and MethodsA total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups.ResultsBaseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0±15.9% vs. 22.9±16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2±19.3 vs. 32.6±21.4, p=0.020), and higher MBG (2.49±0.76 vs. 2.23±0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size.ConclusionA high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.

Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy.

Background and ObjectivesContrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS).Subjects and MethodsA total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI.ResultsThe incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84±22.59% vs. 2.43±24.49%, p=0.038; -11.44±14.00 vs. -9.51±13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026).ConclusionHigh-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.

Preventive effect of statin pretreatment on contrast-induced acute kidney injury in patients undergoing coronary angioplasty: Propensity score analysis from a multicenter registry

BackgroundThe prophylactic benefit of statins in reducing the incidence of contrast-induced acute kidney injury (CI-AKI) has been investigated in several studies with conflicting results. We sought to investigate whether statin pretreatment prevents CI-AKI in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). MethodsA total of 2198 CAD patients who underwent PCI, except for those undergoing dialysis or who died within 7days after angioplasty, were analyzed from the ICAS (Ibaraki Cardiovascular Assessment Study) multicenter registry. Analyzed subjects were divided into 2 groups according to statin pretreatment: statin pretreatment (n=839) and non-statin pretreatment (n=1359). Selection bias of statin pretreatment was adjusted by propensity score-matching method: pretreatment statin (n=565) and non-statin pretreatment (n=565). CI-AKI was defined as an increase in serum creatinine of ≥25% or 0.5mg/dl from baseline within 1week of contrast medium exposure. ResultsA total of 192 (8.7%) patients developed CI-AKI. No significant differences were observed in baseline patient characteristics between the statin and non-statin pretreatment groups after propensity score matching. In the propensity score-matched groups, the incidence of CI-AKI was significantly lower in patients with statin pretreatment than in those without statin pretreatment (3.5% vs.10.6%, odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.18–0.52, P<0.001). Multivariate logistic regression analysis showed that statin pretreatment remained an independent negative predictor of CI-AKI (OR: 0.31, 95% CI: 0.18–0.53, P<0.001) among propensity score-matched subjects. ConclusionsStatin pretreatment was associated with a significant decrease in the risk of CI-AKI in CAD patients undergoing PCI in the ICAS Registry.