Meta-analysis of the role of high-dose statins administered prior to percutaneous coronary intervention in reducing major adverse cardiac events in patients with coronary artery disease

Summary 1. There is considerable evidence regarding the efficacy of statins for the primary and secondary prevention of coronary artery disease (CAD). However, due to lack of sufficient evidence, there is still doubt whether high-dose statin therapy prior to percutaneous coronary intervention (PCI) is beneficial. In the present study, we performed a meta-analysis to evaluate the effect of preoperative high-dose statin therapy on the incidence of major adverse cardiac events (MACE) after successful PCI. 2. Trials were retrieved through Medline (1980–2009) and the reference files limited to English-language articles. Data were abstracted using a standardized protocol and a meta-analysis was performed. 3. Five studies of a total 1789 patients with CAD qualified for analysis. Administration of high-dose statins in CAD patients before PCI was associated with a significant reduction in MACE 30 days after the procedure. The incidence of MACE in the high-dose statin group (6.98%) was significantly lower than that in the placebo group (14.77%), with an odds ratio (OR) of 0.43 (95% confidence interval (CI) 0.31–0.59; P < 0.00001). The incidence of post-PCI increases in creatine kinase MB in the high-dose statin and placebo groups was 9.20%vs 18.83%, respectively (OR 0.43; 95% CI 0.33–0.58; P < 0.00001), whereas the incidence of increases in troponin I was 30.13%vs 44.53%, respectively (OR 0.53; 95% CI 0.43–0.67; P < 0.00001), respectively. 4. In conclusion, high-dose statin therapy before PCI provides a significant benefit over placebo in preventing post-PCI MACE. Findings from the present analysis strongly support a strategy of routine loading of high-dose statins before interventional therapy.