A System Review Of The Efficacy And Safety Of Intensive Statins Therapy Before PCI

Objectives:The system review was performed to evaluate whether intensive statins therapy before PCI can improve the clinical outcomes of patient and the safety of intensive statins therapy.Literatures published at home and abroad about intensive statins therapy before PCI were collected.And through meta-analysis to evaluate the efficacy and safety of intensive statins therapy before PCI.Methods:Chinese and English literature about intensive statins therapy before PCI was retrieved systematically through PubMed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature(CBM),VIP Scientific Journal Database(VIP).Literature was collected from the beginning of the database to August 31,2020.Articles were screened according to inclusion and exclusion strictly.The quality of literature was evaluated by Jadad rating scale.The retrieval,screening,quality assessment and data extraction of literature were performed by two researchers independently.As atorvastatin and rosuvastatin are commonly used in clinical practice at present,the two drugs were systematically evaluated respectively.Review Manager 5.3 statistical software was used for data processing and analysis.The Odds Ratio(OR)and 95%confidence interval(CI)were used to represent the effect size.The inter-group heterogeneity was analyzed by I2 test.When I2 ≤ 50%,there was no inter-group heterogeneity,and fixed effects model was used for the combined analysis.When I2>50%,there was inter-group heterogeneity,and random effects model was used,and subgroup analysis was performed.Results:According to the inclusion and exclusion criteria,29 studies were included in the atorvastatin group,and a total of 3793 patients were enrolled,including 1948 patients in the observation group and 1845 patients in the control group.16 studies were included in the rosuvastatin group,and a total of 2240 patients were enrolled,including 1107 in the observation group and 1133 in the control group.All literatures was prospective,randomized and comparative clinical study.1.A total of 23 trials in the atorvastatin group(2465 patients,1219 in the observation group,and 1246 in the control group)evaluated the number of patients with all-cause or cardiac death after PCI.Results of the meta-analysis showed that intensive atorvastatin treatment before PCI can reduced the number of patients with all-cause or cardiac death(OR=0.27,95%CI[0.12,0.60],P=0.001).27 studies(2842 patients included,1408 in the observation group and 1434 in the control group)evaluated the number of patients with new myocardial infarction after PCI.Meta-analysis results showed that intensive atorvastatin treatment before PCI reduced the incidence of new myocardial infarction after PCI(OR=0.30,95%CI[0.20,0.46],P<0.00001).A total of 20 clinical studies(including 2162 patients,1067 patients in the observation group and 1095 patients in the control group)evaluated the incidence of revascularization after PCI.Results of the meta-analysis showed that intensive atorvastatin treatment before PCI reduced revascularization after PCI(OR=0.30,95%CI[0.16,0.54],P<0.0001).27 clinical studies(including 3506 patients,1744 in the observation group and 1762 in the control group)evaluated the total number of adverse events after PCI.Meta-analysis results showed that intensive atorvastatin treatment before PCI reduced the incidence of adverse events after PCI(OR=0.31,95%CI[0.25,0.39],P<0.00001).A total of 11 clinical studies(including 1228 patients,616 patients in the observation group and 612 patients in the control group)evaluated the adverse drug reactions of intensive atorvastatin treatment before PCI.Results of the meta-analysis showed that intensive atorvastatin treatment before PCI did not increase the incidence of adverse drug reactions(OR=1.47,95%CI[0.82,2.64],P=0.20).2.10 studies in the rosuvastatin group(1060 patients included,534 patients in the observation group,and 526 patients in the control group)evaluated the number of patients with all-cause or cardiac death after PCI.Meta-analysis results showed that intensive rosuvastatin treatment before PCI did not reduce the incidence of all-cause or cardiac death(OR=0.58,95%CI[0.23,1.46],P=0.25).A total of 10 studies(1570 patients included,782 in the observation group and 788 in the control group)evaluated the number of patients with new myocardial infarction after PCI.Results of the meta-analysis showed that intensive rosuvastatin treatment before PCI reduced the incidence of new myocardial infarction after PCI(OR=0.26,95%CI[0.14,0.47],P<0.00001).9 studies(including 915 patients,459 in the observation group and 456 in the control group)evaluated the incidence of revascularization after PCI,and Meta-analysis results showed that intensive rosuvastatin treatment before PCI reduced the incidence of revascularization after PCI(OR=0.38,95%CI[0.19,0.74],P=0.005).A total of 13 studies(1518 patients included,766 patients in the observation group and 752 patients in the control group)evaluated the total number of adverse events after PCI.Results of the meta-analysis showed that intensive rosuvastatin treatment before PCI reduced the incidence of adverse events after PCI(OR=0.39,95%CI[0.29,0.51],P<0.00001).7 studies(754 patients included,384 in the observation group and 370 in the control group)evaluated the adverse drug reactions of intensive rosuvastatin treatment before PCI.Meta-analysis results showed that intensive rosuvastatin treatment before PCI did not increase the incidence of adverse drug reactions(OR=0.96,95%CI[0.48,1.91],P=0.91).Conclusion:According to the results of the Meta analysis,intensive atorvastatin treatment before PCI can reduce the occurrence of major cardiovascular adverse events,and it does not increase the adverse reactions of atorvastatin.Intensive treatment with rosuvastatin before PCI did not reduce the incidence of all-cause or cardiovascular death,but it could reduce the incidence of new myocardial infarction,revascularization and the total number of major cardiovascular adverse events after PCI,and did not increase the adverse reactions of rosuvastatin.