Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy.
Circulation. 2011 Apr 19;123(15):1622-32. doi: 10.1161/CIRCULATIONAHA.110.002451. Epub 2011 Apr 4.
Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients.
We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025).
High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.
先前的研究表明，在接受经皮冠状动脉介入治疗的患者中，他汀类药物预处理可降低心脏事件的发生。然而，大多数数据都是观察性的，并且单一的随机试验纳入的患者数量有限。
我们使用来自 13 项随机研究的个体患者数据进行了协作荟萃分析，其中 3341 例患者在经皮冠状动脉介入治疗前接受了高剂量他汀（n=1692）或无他汀/低剂量他汀（n=1649）治疗，所有患者在介入治疗后均接受他汀类药物治疗。评估围手术期心肌梗死的发生情况，定义为术后肌酸激酶同工酶-MB 升高≥正常上限的 3 倍，以及 30 天主要不良心脏事件（死亡、心肌梗死、靶血管血运重建）。高剂量他汀组的围手术期心肌梗死发生率为 7.0%，对照组为 11.9%，活性治疗组的风险降低了 44%（固定效应模型的比值比为 0.56，95%置信区间为 0.44 至 0.71，P<0.00001）。高剂量他汀组 30 天主要不良心脏事件发生率显著降低（7.4%与 12.6%，风险降低 44%；P<0.00001），1 个月主要不良心脏事件（不包括围手术期事件）也降低（0.6%与 1.4%；P=0.05）。高剂量他汀类药物的益处与临床表现无关（P 交互=0.43），并在各种亚组中得到维持，但在基线 C 反应蛋白水平升高的亚组中效果更大（n=734；围手术期心肌梗死的风险降低 68%，而在 1861 例 CRP 正常的患者中为 31%；定量交互 P=0.025）。
在接受经皮冠状动脉介入治疗的患者中，高剂量他汀类药物预处理可显著降低围手术期心肌梗死和 30 天不良事件的发生。该策略应考虑用于所有计划接受经皮冠状动脉介入治疗的患者。
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