Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

Springer Science and Business Media LLC - Tập 76 Số 1
Bryan Gervais de Liyis1, Gusti Ngurah Prana Jagannatha1, Anastasya Maria Kosasih1, I Kadek Susila Surya Darma2, I Made Junior Rina Artha2
1Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Diponegoro Street, Denpasar, Bali, 80114, Indonesia
2Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana, Prof. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia

Tóm tắt

Abstract Background The impacts of single high-dose statin preloading in patients undergoing percutaneous coronary intervention (PCI) have not been fully examined. This study aims to evaluate post-procedure impacts of single high-dose statin pretreatment with acute coronary syndrome (ACS). Methods The meta-analysis reviewed Cochrane, PubMed, and Medline databases for studies comparing single high-dose atorvastatin or rosuvastatin to placebo in ACS patients undergoing PCI. The primary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), all-cause mortality, and target vessel revascularization (TVR) at three months. Secondary endpoints examined were the TIMI flow grade 3 and left ventricular ejection fraction (LVEF). Results Comprehensive analysis was conducted on fifteen RCTs, encompassing a total of 6,207 patients (3090 vs 3117 patients). The pooled results demonstrated that a single high-dose of statin administered prior to PCI led to a significant decrease in the incidence of MACE at three months post-PCI compared to the control group (OR 0.50, 95%CI 0.35–0.71, p = 0.0001). The occurrence of MI (OR 0.57, 95%CI 0.42–0.77, p = 0.0002), all-cause mortality (OR 0.56, 95%CI 0.39–0.81, p = 0.0002), and TVR (OR 0.56, 95%CI 0.35–0.92, p = 0.02) was significantly lower in the statin single high-dose group compared to the control group. No significant effects on TIMI flow grade 3 (OR 1.20, 95%CI 0.94–1.53, p = 0.14) or left ventricular ejection fraction (OR 2.19, 95%CI − 0.97 to 5.34, p = 0.17) were observed. Subgroup analysis demonstrated reduced incidence of MACE with a single dose of 80 mg atorvastatin (OR 0.66, 95%CI 0.54–0.81, p < 0.0001) and 40 mg rosuvastatin (OR 0.19, 95%CI 0.07–0.54, p = 0.002). Conclusions Single high-dose statin before PCI in patients with ACS significantly reduces MACE, MI, all-cause mortality, and TVR three months post-PCI.

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Tài liệu tham khảo

Patel MR, Dehmer GJ, Hirshfeld JW et al (2009) ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary revascularization. A report by the American College of cardiology foundation appropriateness criteria task force, Society for Cardiovascular Angiography and Interventions, Society of T. J Am Coll Cardiol 53:530–553

Steinhubl SR, Ellis SG, Wolski K et al (2001) Ticlopidine pretreatment before coronary stenting is associated with sustained decrease in adverse cardiac events: data from the evaluation of platelet IIb/IIIa inhibitor for stenting (EPISTENT) trial. Circulation 103:1403–1409

Zeymer U, Zahn R, Schiele R et al (2005) Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial. Eur Heart J 26:1971–1977

Di Sciascio G, Patti G, Pasceri V et al (2010) Effectiveness of in-laboratory high-dose clopidogrel loading versus routine pre-load in patients undergoing percutaneous coronary intervention: results of the ARMYDA-5 PRELOAD (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) ra. J Am Coll Cardiol 56:550–557

Wang L, Peng P, Zhang O et al (2014) 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. PLoS ONE 9:1–21

Zhai C, Cong H, Liu Y et al (2015) Effect of high-dose statin pretreatment on the incidence of periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: grading the evidence through a cumulative meta-analysis. Clin Cardiol 38:668–678

Oesterle A, Laufs U, Liao JK (2017) Pleiotropic effects of statins on the cardiovascular system. Circ Res 120:229–243

Ye H, He F, Fei X et al (2014) High-dose atorvastatin reloading before percutaneous coronary intervention increased circulating endothelial progenitor cells and reduced inflammatory cytokine expression during the perioperative period. J Cardiovasc Pharmacol Ther 19:290–295

Shishehbor MH, Brennan ML, Aviles RJ et al (2003) Statins promote potent systemic antioxidant effects through specific inflammatory pathways. Circulation 108:426–431

Nohria A, Prsic A, Liu PY et al (2009) Statins inhibit Rho kinase activity in patients with atherosclerosis. Atherosclerosis 205:517–521

Eisen A, Leshem-Lev D, Yavin H et al (2015) Effect of high dose statin pretreatment on endothelial progenitor cells after percutaneous coronary intervention (HIPOCRATES Study). Cardiovasc Drugs Ther 29:129–135

Rosenson RS, Tangney CC (1998) Antiatherothrombotic properties of statins: implications for cardiovascular event reduction. JAMA 279:1643–1650

Wang CY, Liu PY, Liao JK (2008) Pleiotropic effects of statin therapy: molecular mechanisms and clinical results. Trends Mol Med 14:37–44

Byrne RA, Rossello X, Coughlan JJ et al (2023) ESC Guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. https://doi.org/10.1093/EURHEARTJ/EHAD191

Adel EM, Elberry AA, Abdel Aziz A et al (2022) Comparison of the treatment efficacy of rosuvastatin versus atorvastatin loading prior to percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Clin Med. https://doi.org/10.3390/jcm11175142

Briguori C, Visconti G, Focaccio A et al (2009) Novel approaches for preventing or limiting events (Naples) II trial. Impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol 54:2157–2163

Chen M, Li H, Wang Y (2013) Protection by atorvastatin pretreatment in patients undergoing primary percutaneous coronary intervention is associated with the lower levels of oxygen free radicals. www.jcvp.org

Guo J, Zhang W-H, Zhao Q et al (2017) Study on the effect of different doses of rosuvastatin on ventricular remodeling in patients with acute coronary syndrome after emergency percutaneous coronary intervention. Eur Rev Med Pharmacol Sci 21:4457–4463

Hahn JY, Kim HJ, Choi YJ et al (2011) Effects of atorvastatin pretreatment on infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J 162:1026–1033

Kim JW, Yun KH, Kim EK et al (2014) Effect of high dose rosuvastatin loading before primary percutaneous coronary intervention on infarct size in patients with ST-segment elevation myocardial infarction. Korean Circ J 44:76–81

Kim EK, Hahn JY, Bin SY et al (2015) Effects of high-dose atorvastatin pretreatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a cardiac magnetic resonance study. J Korean Med Sci 30:435–441

Ko YG, Won H, Shin DH et al (2014) Efficacy of early intensive rosuvastatin therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (ROSEMARY study). Am J Cardiol 114:29–35

Liu HL, Yang Y, Yang SL et al (2013) Administration of a loading dose of atorvastatin before percutaneous coronary intervention prevents inflammation and reduces myocardial injury in stemi patients: a randomized clinical study. Clin Ther 35:261–272

Liu Z, Joerg H, Hao H et al (2016) Efficacy of high-intensity atorvastatin for Asian patients undergoing percutaneous coronary intervention. Ann Pharmacother 50:725–733

Lopes RD, De Barros E, Silva PGM, De Andrade JI et al (2018) Timing of loading dose of atorvastatin in patients undergoing percutaneous coronary intervention for acute coronary syndromes: insights from the SECURE-PCI randomized clinical trial. JAMA Cardiol 3:1113–1118

García-Méndez RC, Almeida-Gutierrez E, Serrano-Cuevas L et al (2018) Reduction of no reflow with a loading dose of atorvastatin before primary angioplasty in patients with acute ST myocardial infarction. Arch Med Res 49:620–629

Post S, Post MC, Van Den Branden BJ et al (2012) Early statin treatment prior to primary PCI for acute myocardial infarction: REPERATOR, a randomized placebo-controlled pilot trial. Catheter Cardiovasc Interv 80:756–765

Wang Z, Dai H, Xing M et al (2013) Effect of a single high loading dose of rosuvastatin on percutaneous coronary intervention for acute coronary syndromes. J Cardiovasc Pharmacol Ther 18:327–333

Yun KH, Oh SK, Rhee SJ et al (2011) 12-month follow-up results of high dose rosuvastatin loading before percutaneous coronary intervention in patients with acute coronary syndrome. Int J Cardiol 146:68–72

Patti G, Cannon CP, Murphy SA et al (2011) Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies. Circulation 123:1622–1632

Benjo AM, El-Hayek GE, Messerli F et al (2015) High dose statin loading prior to percutaneous coronary intervention decreases cardiovascular events: a meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 85:53–60

Soud M, Ho G, Kuku KO et al (2018) Impact of statins preloading before PCI on periprocedural myocardial infarction among stable angina pectoris patients undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials. Cardiovasc Revasc Med 19:971–975

Navarese EP, Kowalewski M, Andreotti F et al (2014) Meta-analysis of time-related benefits of statin therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol 113:1753–1764

Anayat S, Majid K, Nazir HS et al (2023) Meta-analysis on the efficacy of high-dose statin loading before percutaneous coronary intervention in reducing no-reflow phenomenon in acute coronary syndrome. Am J Cardiol 195:9–16

Adel EM, Elberry AA, Abdel Aziz A et al (2022) Comparison of the treatment efficacy of rosuvastatin versus atorvastatin loading prior to percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Clin Med. https://doi.org/10.3390/jcm11175142

Yanai H, Adachi H, Hakoshima M et al (2022) Molecular biological and clinical understanding of the statin residual cardiovascular disease risk and peroxisome proliferator-activated receptor alpha agonists and ezetimibe for its treatment. Int J Mol Sci. https://doi.org/10.3390/ijms23073418

Jarr KU, Ye J, Kojima Y et al (2022) The pleiotropic benefits of statins include the ability to reduce CD47 and amplify the effect of pro-efferocytic therapies in atherosclerosis. Nat Cardiovasc Res 1:253–262

Ridker PM, Everett BM, Thuren T et al (2017) Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 377:1119–1131

Ma J, Chen X (2021) Anti-inflammatory therapy for coronary atherosclerotic heart disease: unanswered questions behind existing successes. Front Cardiovasc Med. https://doi.org/10.3389/fcvm.2020.631398

Albert MA, Danielson E, Rifai N et al (2001) Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study. JAMA 286:64–70

Umrani S, Jamshed W, Rizwan A (2020) Comparison of atorvastatin and rosuvastatin in reduction of inflammatory markers in acute coronary syndrome. Cureus 12:10–13

Mani P, Puri R, Schwartz GG et al (2019) Association of initial and serial C-reactive protein levels with adverse cardiovascular events and death after acute coronary syndrome: a secondary analysis of the VISTA-16 trial. JAMA Cardiol 4:314–320

Pan Y, Tan Y, Li B et al (2015) Efficacy of high-dose rosuvastatin preloading in patients undergoing percutaneous coronary intervention: a meta-analysis of fourteen randomized controlled trials. Lipids Health Dis 14:1–12

Chitose T, Sugiyama S, Sakamoto K et al (2014) Effect of a hydrophilic and a hydrophobic statin on cardiac salvage after ST-elevated acute myocardial infarction: a pilot study. Atherosclerosis 237:251–258

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