OBJECTIVES: The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. BACKGROUND: Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction (MI) and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. METHODS: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS: Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural MI (risk ratio [RR]: 0.57, 95% confidence interval [CI]: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (RR: 0.66, 95% CI: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (RR: 0.54, 95% CI: 0.43 to 0.68, p < 0.0001). CONCLUSIONS: Statins administered before invasive procedures significantly reduce the hazard of post-procedural MI. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered.
OBJECTIVES: The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. BACKGROUND: Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction (MI) and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. METHODS: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS: Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural MI (risk ratio [RR]: 0.57, 95% confidence interval [CI]: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (RR: 0.66, 95% CI: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (RR: 0.54, 95% CI: 0.43 to 0.68, p < 0.0001). CONCLUSIONS: Statins administered before invasive procedures significantly reduce the hazard of post-procedural MI. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered.
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Authors: Otavio Berwanger; Eliana Vieira Santucci; Pedro Gabriel Melo de Barros E Silva; Isabella de Andrade Jesuíno; Lucas Petri Damiani; Lilian Mazza Barbosa; Renato Hideo Nakagawa Santos; Ligia Nasi Laranjeira; Flávia de Mattos Egydio; Juliana Aparecida Borges de Oliveira; Frederico Toledo Campo Dall Orto; Pedro Beraldo de Andrade; Igor Ribeiro de Castro Bienert; Carlos Eduardo Bosso; José Armando Mangione; Carisi Anne Polanczyk; Amanda Guerra de Moraes Rego Sousa; Renato Abdala Karam Kalil; Luciano de Moura Santos; Andrei Carvalho Sposito; Rafael Luiz Rech; Antônio Carlos Sobral Sousa; Felipe Baldissera; Bruno Ramos Nascimento; Roberto Rocha Corrêa Veiga Giraldez; Alexandre Biasi Cavalcanti; Sabrina Bernardez Pereira; Luiz Alberto Mattos; Luciana Vidal Armaganijan; Hélio Penna Guimarães; José Eduardo Moraes Rego Sousa; John Hunter Alexander; Christopher Bull Granger; Renato Delascio Lopes Journal: JAMA Date: 2018-04-03 Impact factor: 56.272
Authors: Steven M Brunelli; Sushrut S Waikar; Brian T Bateman; Tara I Chang; Joyce Lii; Amit X Garg; Wolfgang C Winkelmayer; Niteesh K Choudhry Journal: Am J Med Date: 2012-10-09 Impact factor: 4.965