Tuo Zhang1, Ling-Hong Shen, Liu-Hua Hu, Ben He. 1. Department of Cardiology, Ren Ji Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, PR China.
Abstract
BACKGROUND: Retrospective and prospective studies have demonstrated that statins have a protective effect in preventing contrast-induced nephropathy (CIN), but there are currently no established guidelines for statin timing or dosage. A systematic review and meta-analysis was performed to determine whether statin administration is protective and the magnitude of their effect. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, CNKI and ISI Proceedings for cohort studies comparing the CIN incidence in a chronic statin pretreatment group and a statin-naïve group, as well as for randomized controlled trials (RCTs) comparing short-term high-dose to short-term low-dose statin treatment or placebo. CIN was defined as an increase in serum creatinine >25% or 0.5 mg/dl (44.2 μmol/l). Qualitative analysis of cohort studies and quantitative analysis of RCTs to estimate pooled risk ratios were performed. RESULTS: Among 6 cohort studies, 4 showed chronic statin pretreatment had a preventive effect against CIN. From 6 RCTs, 1,194 patients were included in the meta-analysis. Under the fixed-effects model, a nonsignificant protective trend toward decreased incidence of CIN with periprocedural short-term high-dose statin treatment was seen (RR: 0.70; 95% CI: 0.48-1.02). CONCLUSION: Current data are not conclusive to whether statins are protective for CIN due to the inherent limitations of the included studies. In the future, large well-designed studies are needed to address the effect of this drug and its longer-term clinical outcomes.
BACKGROUND: Retrospective and prospective studies have demonstrated that statins have a protective effect in preventing contrast-induced nephropathy (CIN), but there are currently no established guidelines for statin timing or dosage. A systematic review and meta-analysis was performed to determine whether statin administration is protective and the magnitude of their effect. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, CNKI and ISI Proceedings for cohort studies comparing the CIN incidence in a chronic statin pretreatment group and a statin-naïve group, as well as for randomized controlled trials (RCTs) comparing short-term high-dose to short-term low-dose statin treatment or placebo. CIN was defined as an increase in serum creatinine >25% or 0.5 mg/dl (44.2 μmol/l). Qualitative analysis of cohort studies and quantitative analysis of RCTs to estimate pooled risk ratios were performed. RESULTS: Among 6 cohort studies, 4 showed chronic statin pretreatment had a preventive effect against CIN. From 6 RCTs, 1,194 patients were included in the meta-analysis. Under the fixed-effects model, a nonsignificant protective trend toward decreased incidence of CIN with periprocedural short-term high-dose statin treatment was seen (RR: 0.70; 95% CI: 0.48-1.02). CONCLUSION: Current data are not conclusive to whether statins are protective for CIN due to the inherent limitations of the included studies. In the future, large well-designed studies are needed to address the effect of this drug and its longer-term clinical outcomes.