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Meta-analysis: Statins yield post-procedural MI benefit when administrated prior to invasive procedures
Winchester D. J Am Coll Cardiol. 2010;56:1099-1109.
Eagle K. J Am Coll Cardiol. 2010;56:1110-1112.
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The administration of statins prior to procedures like percutaneous coronary intervention and CABG was linked with reductions in the risk for post-procedural MI, results from a meta-analysis suggested.
The researchers conducted a computerized search of literature in both MEDLINE and Cochrane databases, and included 21 studies in which statins had been administered prior to invasive procedures. The meta-analysis study population totaled 4,805 patients in whom PCI was typically performed as an elective procedure, although four of the studies included patients with acute coronary. The primary endpoints of interest were post-procedural nonfatal MI; secondary outcomes included all-cause mortality, revascularization and atrial fibrillation.
According to the study results, post-procedural MI was reduced with pre-procedural statin therapy vs. patients in control groups (RR=0.57; 95% CI, 0.46-0.70). Specifically, the incidence of post-procedural MI was 7.5% with statin therapy vs. 13.3% for the controls (P<.0001). In trials where periprocedural MI was defined as creatine kinase-myocardial band (CK-MB) >3 times the upper limit of normal, the MI reduction remained (P=.003). Reductions in all-cause mortality in patients receiving pre-procedural statin therapy were reported, but did not approach statistical significance (RR=0.66; 95% CI, 0.37-1.17). Repeat revascularization in the PCI studies trended in favor of the statin treatment arms (P=.09). In addition, post-operative AF was lower in the statin arms of the CABG studies vs. controls (19% vs. 37%, P<.0001).
“Pre-procedural statin therapy should become an increasingly important strategy to improve the safety of invasive procedures,” the researchers concluded.
In an accompanying editorial, Kim A. Eagle, MD, and Vineet Chopra, MD, both of the University of Michigan Health System in Ann Arbor, asserted that the answer to whether or not patients undergoing invasive coronary procedures should routinely be treated with statin therapy (which they colloquially referred to as “an old friend”) has been answered in the affirmative.
“The available evidence creates a convincing argument for statin treatment before coronary procedures,” they wrote. “Given the strong biological rationale and the sum of individual clinical data, no patient should undergo coronary procedures without statin therapy unless clear contraindications exist. Indeed, it is time to consider a new indication for an old friend.”