BACKGROUND: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. METHODS AND RESULTS: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). CONCLUSIONS: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.
BACKGROUND: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. METHODS AND RESULTS: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). CONCLUSIONS: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.
Authors: Renato D Lopes; Pedro G M de Barros E Silva; Isabella de Andrade Jesuíno; Eliana Vieira Santucci; Lilian Mazza Barbosa; Lucas Petri Damiani; Renato Hideo Nakagawa Santos; Ligia Nasi Laranjeira; Frederico Toledo Campo Dall Orto; Pedro Beraldo de Andrade; Igor Ribeiro de Castro Bienert; John H Alexander; Christopher B Granger; Otavio Berwanger Journal: JAMA Cardiol Date: 2018-11-01 Impact factor: 14.676
Authors: Giampaolo Niccoli; Andrea Celestini; Camilla Calvieri; Nicola Cosentino; Elena Falcioni; Roberto Carnevale; Cristina Nocella; Francesco Fracassi; Marco Roberto; Roberta P Antonazzo; Pasquale Pignatelli; Filippo Crea; Francesco Violi Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-09-05
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: Otavio Berwanger; Yannick Le Manach; Erica Aranha Suzumura; Bruce Biccard; Sadeesh K Srinathan; Wojciech Szczeklik; Jose A Espirito Santo; Eliana Santucci; Alexandre B Cavalcanti; R Andrew Archbold; P J Devereaux Journal: Eur Heart J Date: 2015-09-01 Impact factor: 29.983