High-Dose Statin Pretreatment for the Prevention of Contrast-Induced Nephropathy: A Meta-analysis

• Published in: Canadian journal of cardiology 2011-11, Vol.27 (6), p.851-858
• Main Authors: Zhang, Bu-Chun, MD, PhD, Li, Wei-Ming, MD, Xu, Ya-Wei, MD, FACC
• Format: Article
• Language: English
• Subjects: Cardiovascular; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Disease - diagnostic imaging; Dose-Response Relationship, Drug; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Kidney Diseases - chemically induced; Kidney Diseases - prevention & control
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2011.05.005

Abstract Background Contrast-induced nephropathy (CIN) is a rare but serious complication following contrast-based procedures. Statins have been postulated to prevent CIN via various mechanisms. However, the outcomes following statin administration to prevent CIN have been inconsistent. Methods A meta-analysis of published randomized clinical trials was performed to determine if short-term administration of high-dose statin is superior to conventional-dose statin or placebo among patients undergoing catheterization and interventional procedures in preventing CIN. Results Data were combined across 8 published clinical trials in which 1423 patients were identified. Pooled analyses showed that short-term high-dose statin treatment can decrease the occurrence of CIN (risk ratio 0.51, 95% confidence interval [CI], 0.34-0.77; P = 0.001) and 48-hour serum creatinine level (standardized mean difference [SMD] –0.07 mg/dL; 95% CI, –0.11 to –0.04 mg/dL; P < 0.00001). However, subgroup analysis showed that statin pretreatment cannot decrease the occurrence of CIN in patients with preexisting renal impairment (RR 0.90; 95% CI, 0.49-1.65; P = 0.73). No evidence of publication bias was detected. Conclusions This meta-analysis supports the effectiveness of short-term high-dose statin pretreatment for both decreasing the level of serum creatinine and reducing the rate of CIN in patients undergoing diagnostic and interventional procedures requiring contrast media. However, prospective clinical trials will be needed to draw a definitive conclusion in this area.