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Meta-Analysis
. 2019 Apr 16;13:1233-1240.
doi: 10.2147/DDDT.S196588. eCollection 2019.

Effect of Loading Dose of Atorvastatin Therapy Prior to Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: A Meta-Analysis of Six Randomized Controlled Trials

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Free PMC article
Meta-Analysis

Effect of Loading Dose of Atorvastatin Therapy Prior to Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: A Meta-Analysis of Six Randomized Controlled Trials

Mingfeng Ma et al. Drug Des Devel Ther. .
Free PMC article

Abstract

Purpose: The study sought to summarize the evidence of pre-procedural atorvastatin therapy to improve the prognosis of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Patients and methods: We searched PubMed and Embase from inception to July 2018 for randomized controlled trials that compared loading dose atorvastatin pretreatment with no or low dose for the prevention of cardiovascular events. The primary end points were all-cause mortality and myocardial infarction (MI) at 30 days. The secondary end point was 30-day major adverse cardiovascular events (MACE), a composite of all-cause mortality, MI, and revascularization.

Results: Six trials with 4,991 individuals were included in our meta-analysis. High-dose atorvastatin preloading before PCI was associated with a 27% relative reduction in MI (OR: 0.73, 95% CI, 0.56-0.94, P=0.015). All-cause mortality was nonsignificantly reduced by early treatment with high-potency atorvastatin (OR: 0.94, 95% CI, 0.69-1.30, P=0.725). There was a 20% reduction in MACE in the group of patients treated with statin loading prior to PCI (OR: 0.80, 95% CI, 0.66-0.97, P=0.026). When stratified according to the diagnosis of ACS, the results of MACE were only significant for those ST-elevation myocardial infarction patients undergoing PCI (OR: 0.67, 95% CI, 0.48-0.94, P=0.022) and were not noted in the group of non-ST elevation ACS patients (OR: 0.65, 95% CI, 0.35-1.22, P=0.179).

Conclusion: High-dose atorvastatin pretreatment leads to a significant reduction in MI and MACE at 30 days in ACS patients undergoing PCI, especially in ST-segment elevation MI.

Keywords: acute coronary syndrome; adverse events; atorvastatin; percutaneous coronary intervention.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of study selection. Abbreviations: CABG, coronary artery bypass grafting; CAD, coronary artery disease; ACS, acute coronary syndrome.
Figure 2
Figure 2
Pooled risk ratio (RR) of loading dose of atorvastatin pretreatment vs control for 30-day all-cause mortality (A) and myocardial infarction (B) after percutaneous coronary intervention.
Figure 3
Figure 3
Subgroup analysis of forest plot of risk ratio (RR) and 95% CI for 30-day major adverse composite end point in patients with STEMI (A) and NSTE-ACS (B). Abbreviations: STEMI, ST-segment elevation myocardial infarction; NSTE-ACS, non-ST segment elevation acute coronary syndrome.
Figure 4
Figure 4
Funnel plot of included studies for all-cause mortality (A) and myocardial infarction (B). Abbreviations: RR, risk ratio; MI, myocardial infarction.

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