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High-dose statin reduced risk for contrast-induced nephropathy
High-dose rosuvastatin at admission reduced the occurrence of contrast-induced acute kidney injury in patients with ACS and elevated high-sensitivity C-reactive protein levels who were undergoing coronary intervention.
The PRATO-ACS study included 504 statin-naive patients with non-ST elevation ACS scheduled for early invasive strategy. Patients were randomly assigned placebo or rosuvastatin 40 mg (Crestor, AstraZeneca) on admission to the coronary care unit, followed by 20 mg daily until discharge. Researchers stratified the patients into three groups based on baseline high-sensitivity C-reactive protein (hs-CRP) levels: <2.7 mg/L, ≥2.7 to <7.5 mg/L and ≥7.5 mg/L.
Contrast-induced acute kidney injury — defined as creatinine ≥0.5 mg/dL or ≥25% above baseline within 72 hours — served as the primary outcome measure.
The rate of the primary endpoint among patients in the lowest tertile of baseline hs-CRP was 5.4% compared with 8.7% among those in the middle tertile and 18.3% in the highest tertile (P=.0001).
Patients in the highest tertile group experienced the most significant benefit of rosuvastatin therapy (OR=0.2; 95% CI, 0.07-0.54). Among patients in the highest tertile, 30-day adverse event rates were 7.2% among patients assigned rosuvastatin vs. 17.4% among patients assigned placebo (P=.043). Better 6-month outcomes were also reported in patients assigned rosuvastatin in the highest tertile of baseline hs-CRP compared with patients assigned placebo (6.02% vs. 13.04%; P=.12).
“High-dose rosuvastatin administered on admission appears to exert more effective kidney protection in ACS subjects with higher baseline [high-sensitivity C-reactive protein] levels resulting in better short- and mid-term clinical outcome,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.