Meta-Analysis of Time-Related Benefits of Statin Therapy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Patients with acute coronary syndromes (ACSs) still experience high rates of recurrent coronary events, particularly, early in their presentation. Statins yield substantial cardiovascular benefits, but the optimal timing of their administration, before or after percutaneous coronary intervention (PC...

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Bibliographic Details
Published in:The American journal of cardiology 2014-05, Vol.113 (10), p.1753-1764
Main Authors: Navarese, Eliano Pio, MD, PhD, Kowalewski, Mariusz, MD, Andreotti, Felicita, MD, PhD, van Wely, Marleen, MD, Camaro, Cyril, MD, Kolodziejczak, Michalina, MD, Gorny, Bartosz, MD, Wirianta, Jeffrey, MD, Kubica, Jacek, MD, PhD, Kelm, Malte, MD, de Boer, Menko-Jan, MD, Suryapranata, Harry, MD, PhD
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - therapy
Acute coronary syndromes
Cardiovascular
Clinical outcomes
Coronary vessels
Follow-Up Studies
Heart attacks
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Percutaneous Coronary Intervention
Preoperative Care - methods
Statins
Time Factors
Treatment Outcome
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Summary:Patients with acute coronary syndromes (ACSs) still experience high rates of recurrent coronary events, particularly, early in their presentation. Statins yield substantial cardiovascular benefits, but the optimal timing of their administration, before or after percutaneous coronary intervention (PCI), remains unclear. We aimed to perform a meta-analysis of randomized controlled trials of statin administration before or after PCI versus no statin or low-dose statin in patients with ACS. Primary end points were 30-day all-cause mortality and 30-day myocardial infarction (MI) stratified by pre- and post-PCI statin administration. Secondary end points were major adverse cardiac events (MACEs) or major adverse cardiac and cerebrovascular events (MACCEs). Long-term analysis beyond 30 days was also performed. Twenty randomized controlled trials enrolling 8,750 patients were included. At 30 days, the rate of MI was significantly lower in the statin group (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.53 to 0.84, p = 0.0007) with a trend toward reduced mortality (p = 0.06) and significant reductions in MACE and MACCE compared with no or low-dose statin. The 30-day incidence of MI was markedly lower when statins were administered before PCI (OR 0.38, 95% CI 0.24 to 0.59, p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2014.02.034