Intensive versus non-intensive statin pretreatment before percutaneous coronary intervention in Chinese patients: a meta-analysis of randomized controlled trials

Abstract Background: The results of intensive statin pretreatment before percutaneous coronary intervention (PCI) is inconsistent between Chinese and Western populations and there are no corresponding meta-analyses involving hard clinical end-points in the available published literature. The aim of this study was to evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through a meta-analysis. Method: Relevant studies were identified by searching the electronic databases of PubMed, Embase, and Cochrane’s Library to December 2019. The outcomes included an assessment of major adverse cardiovascular event (MACE), non-fatal myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), myalgia/myasthenia and abnormal alanine aminotransferase (ALT) in all enrolled patients. Results: 12 studies involving 3,183 individuals were included．The results showed statistically significant different in the incidence of MACE (RR=0.49, 95% CI: 0.30-0.80, P=0.004, I2=63%) and non-fatal MI (RR=0.54, 95% CI: 0.33-0.88, P= 0.01, I2=62%) on comparing the intensive statin and non-intensive statin treatment groups. Subgroup analysis further suggested the benefits of different treatments were inconsistent. Compared with preoperative intensive statin therapy, the incidence of MACE and non-fatal MI were significantly elevated in patients receiving placebo or no statin treatment before surgery (RR=0.47, 95% CI: 0.34-0.65, P<0.00001, I2=0%; RR=0.49, 95% CI: 0.35-0.70, P<0.0001, I2=0%). However, the incidence of MACE and non-fatal MI were not statistically significant when comparing preoperative high-intensity statin therapy with moderate-intensity statin therapy (RR=0.96, 95% CI: 0.44-2.08, P=0.91, I2=11%; RR=1.10, 95% CI: 0.86-1.39, P=0.44). The study also demonstrated that the Asian population could tolerate high-intensity atorvastatin during the perioperative period. Conclusion: Compared with placebo or no statin pretreatment, Chinese patients receiving intensive statin therapy before PCI displayed reduced incidence of MACE and non-fatal MI. However, there was no significant benefit between high-intensity and moderate-intensity statin treatment. Further, the Chinese population tolerated well preoperative intensive statin pretretment.