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

Background: Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this metaanalysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention.Methods: We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment.Results: Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.49; P, 0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45-0.83; P50.002). The benefit of highdose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50-0.95; P50.02) and prior low dose statin-treated patients (OR:0.28; 95% CI: 0.12-0.65; P50.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34-0.79; P50.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45-1.10; P50.12). Long-term effects on survival were less obvious.Conclusions: High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of highdose statin pretreatment on PMI and MACE is significant for statin-naive patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome.