To date, the randomized trials of this strategy have been relatively small, explain Dr. Giuseppe Patti, at Campus Bio-Medico University of Rome, Italy, and colleagues. They therefore conducted a meta-analysis of patient-level data from 13 prospective randomized trials, covering 1692 PCI patients who were randomized to high-dose statin and 1649 who received low-dose or no statin therapy.
The duration of pre-PCI statin treatment ranged from less than 12 hours to longer than 2 weeks. “There were no differences in periprocedural antithrombotic therapies between high-dose statin pretreatment and control groups in any of the studies,” the authors report.
They found that the incidence of periprocedural MI was 7.0% in the high-dose statin group versus 11.9% in the control group (odds ratio, 0.56; p<0.00001).
The risk of 30-day major adverse cardiac events (MACE), excluding periprocedural events, was reduced to a similar degree. The rate in the two arms was 0.6% versus 1.4% (p=0.05), according to the report.
“In addition,” the authors note, “the benefit was observed in patients receiving dual-antiplatelet therapy (aspirin and a thienopyridine) and in those receiving triple-antiplatelet therapy (also receiving glycoprotein IIb/IIIa inhibitors).”
While all subgroups benefitted from high-dose statin therapy, the effect was most pronounced in patients with elevated C-reactive protein; in this subset, there was a 68% risk reduction compared to 31% in patients with normal CRP.
Based on the findings, “a strategy of high-dose statin pretreatment should be used routinely in patients undergoing PCI, irrespective of clinical presentation and chronic statin therapy,” Dr. Patti and colleagues suggest.
They add that the cost-effectiveness of this strategy is likely to be very favorable, “because there was no risk excess associated with high-dose loading with statins before the procedure (none of the trials reported significant side effects), and the cost of a few doses of statin is negligible.”