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SECURE-PCI: Atorvastatin loading dose beneficial in STEMI before PCI

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Renato D. Lopes

SAN DIEGO — In a secondary analysis from the SECURE-PCI trial, a periprocedural loading dose of atorvastatin reduced 30-day MACE rates in patients with STEMI undergoing PCI, researchers reported at TCT 2018.

The treatment effect of atorvastatin was not significant in patients with non-ST-elevation ACS (NSTEACS), and the timing of atorvastatin administration did not appear to matter, Renato D. Lopes, MD, MHS, PhD, professor of medicine in the division of cardiology at Duke University Medical Center, said during a presentation.

As Cardiology Today’s Intervention previously reported, in the overall cohort of patients who had ACS and were planned for revascularization with PCI from SECURE-PCI, an atorvastatin loading dose did not affect 30-day rates of MACE, defined as all-cause mortality, MI, stroke or unplanned coronary revascularization.

However, in the main study, atorvastatin preloading conferred better 30-day MACE outcomes among patients who actually went PCI.

Therefore, Lopes said, “We hypothesize that the potential benefit of loading statins pre-PCI might be related to the timing of the statin administration before PCI.”

For the present analysis, the researchers analyzed the 2,710 patients (64.7% of the overall cohort) who actually underwent PCI (mean age, 62 years; 24% women) to determine whether 30-day MACE rates differed by type of ACS and by timing of atorvastatin administration before PCI. The findings were simultaneously published in JAMA Cardiology.

Risk for 30-day MACE was reduced by 28% in those who actually had PCI (adjusted HR = 0.72; 95% CI, 0.54-0.97). By contrast, there was no effect in patients who did not have PCI (aHR = 1.44; 95% CI, 0.92-2.24; P for interaction = .01).

In addition, Lopes said, the treatment effect of atorvastatin preloading for the primary outcome was significant in patients with STEMI (aHR = 0.59; 95% CI, 0.38-0.92) but not in patients with NSTEACS (aHR = 0.85; 95% CI, 0.58-1.27; P for interaction = .22).

Among those who underwent PCI, the timing of atorvastatin did not affect 30-day MACE in the overall cohort (P for interaction = .44), in the STEMI cohort (P for interaction = .69) or in the NSTEACS cohort (P for interaction = .3), according to the researchers.

“Considering the well-known safety of atorvastatin, treating ACS patients, in particular with STEMI, with loading doses of statin as early as possible before PCI is a reasonable approach that may improve short-term clinical outcomes,” Lopes said during the presentation. – by Erik Swain

References:

Lopes RD, et al. Keynote Interventional Studies VIII: Pharmacotherapy Trials and High Bleeding Risk Patients. Presented at: TCT Scientific Symposium; Sept. 21-25, 2018; San Diego.

Lopes RD, et al. JAMA Cardiol. 2018;doi:10.1001/jamacardio.2018.3408.

Disclosures: Lopes reports he received grants from Amgen; personal fees from Bayer, Boehringer Ingelheim and Portola; and grants and personal fees from Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, and Sanofi-Aventis outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.