| Objective:The meta-analysis was performed to evaluate whether loading-dose statins administered before percutaneous coronary intervention (PCI) procedure can reduce the incidence of30-day major adverse coronary events (MACE) or decrease the incidence of post-procedural increase in creatine kinase MB isoenzyme (CK-MB) and cardiac troponin I (cTNI) levels. The safety of the administration of loading-dose statins was also assessed.Methods:Prospective randomized controlled clinical trials concerning PCI and loading-dose statins therapy were retrieved through Medline, ClinicalTrials.gov, EBSCO and web of knowledge (Jan1980to Dec2012) and references limited to English-language articles. Trials with a JADAD score≥4were qualified for inclusion. Using a standardized protocol, the incidence of MACE, the incidences of elevated CK-MB/cTNI/ALT/AST or CK≥1time and3times the upper limit of normal (ULN) were extracted. A software of RevMan5.2was used for meta-analysis.Results:1) A total of18randomized controlled trials which enrolled4157patients were included in this meta-analysis,2093patients received loading-dose statins and2064patients received placebos. Male3010subjects and female1147subjects, and the mean age was64.1±10.4years old. 2) The occurrence of30-day MACE (death, myocardial infarction and target-vessel revascularization) after PCI procedure were evaluated in11trials (including a total of3098patients,1573patients in the statin group and1525patients in the control group). The incidence of MACE in the statin group was significantly lower than that in the control group (6.2%vs12.4%; OR:0.44,95%CI:0.34-0.57, P<0.00001).3) Eleven trials (including1975patients in total,1019patients in the statin group and956patients in the control group) assessed the post-procedural increase in CK-MB>1x ULN and6trials (including1820patinets in all,918patients in the statin group and902patients in the control group) assessed the increase in CK-MB≥3x ULN. The incidence of increased CK-MB>1x ULN in the statin group was markedly lower than that in the control group (13.2%vs25.1%; OR:0.39,95%CI:0.30-0.50, P<0.00001). Similarly, the incidence of post-procedural increase of CK-MB≥3x ULN in the statin group was significantly lower than that in the control group (9%vs15.7%; OR:0.53,95%CI:0.40-0.71, P<0.0001).4) The post-procedural increase in cTNI>1x ULN was provided in12trials (including2585patients in all,1325patients in the statin group and1260patients in the control group) and the meta-analysis showed that the incidence of increased cTNI>1x ULN was significantly lower in the statin group than in the control group (38.6%vs49.7%; OR:0.54,95%CI:0.36-0.81, P<0.005). Four trials (including1395patients in total,704patients in the statin group and691patients in the control group) evaluated the increase in cTNI≥3x ULN and the incidence of increased cTNI≥3x ULN was dramatically lower in the statin group than that in the control group (17.6%vs30%; OR:0.43,95%CI:0.20-0.97, P<0.05).5) Patients with elevated serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) more than3x ULN were assessed in13trials (including3326patients,1689patients in the statin group and1637patients in the control group). The results of meta-analysis showed there was no significant difference for the incidence of ALT/AST>3x ULN between the statin group and the control group (0.7%vs0.4%) and the risk difference (RD) between them was very small (RD:0.00;95%CI:-0.00-0.01, P=0.52). There were9trials including2434patients (1242 patients in the statin group and1192patients in the control group) evaluated the incidence of elevated CK>3x ULN and the meta-analysis showed that no significant difference was found the between the statin group and the control group (1.4%vs0.8%, RD:0.01;95%CI:-0.00-0.02, P=0.21).Conclusions:Administration of loading-dose statin prior to PCI procedure leads to a significant decrease in the incidence of30-day MACE and a significant reduction in the post-procedural increased CK-MB and cTNI levels without any increases of statin’s adverse effects. |
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