Yang Xian, Lan Xi, Zhang Xin-Lin, Han Zhong-Lin, Yan Si-Min, Wang Wen-Xiao, Xu Biao, Ge Wei-Hong
Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China.
Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China.
World J Clin Cases. 2022 Feb 16;10(5):1557-1571. doi: 10.12998/wjcc.v10.i5.1557.
The results of intensive statin pretreatment before percutaneous coronary intervention (PCI) is inconsistent between Chinese and Western populations, and there are no corresponding meta-analyses involving hard clinical endpoints in the available published literature.
To evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through a meta-analysis.
Relevant studies were identified by searching the electronic databases of PubMed, Embase and Cochrane's Library to December 2019. The outcomes included an assessment of major adverse cardiovascular event (MACE), non-fatal myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), myalgia /myasthenia and abnormal alanine aminotransferase (ALT) in all enrolled patients. Random effect model and fixed effect model were applied to combine the data, which were further analyzed by test and test. The main outcomes were then analyzed through the use of relative risks (RR) and its 95% confidence interval (95%CI).
Eleven studies involving 3123 individuals were included. Compared with patients receiving placebo or no statin treatment before surgery, intensive statin treatment was associated with a clear reduction of risk of MACE (RR = 0.44, 95%CI: 0.31-0.61, < 0.00001). However, compared with the patients receiving moderate-intensity statin before surgery, no advantage to intensive statin treatment was seen (RR = 1.04, 95%CI: 0.82-1.31, = 0.74). In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR (RR = 0.43, 95%CI: 0.18-1.02, = 0.06) , myalgia /myasthenia (RR = 1.35, 95%CI: 0.30-5.95, = 0.69) and abnormal alanine aminotransferase (RR = 1.47, 95%CI: 0.54-4.02, = 0.45) except non-fatal MI (RR = 0.54, 95%CI: 0.33-0.88, = 0.01).
Compared with placebo or no statin pretreatment, intensive statin before PCI displayed reduced incidence of MACE. However, there was no significant benefit between high and moderate-intensity statin. In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR, myalgia/myasthenia and abnormal alanine aminotransferase except non-fatal MI.
经皮冠状动脉介入治疗（PCI）前强化他汀预处理在中国人群和西方人群中的结果不一致，现有已发表文献中尚无涉及硬临床终点的相应荟萃分析。
通过荟萃分析评估PCI前大剂量负荷他汀在中国患者中的有效性和安全性。
通过检索截至2019年12月的PubMed、Embase和Cochrane图书馆电子数据库来确定相关研究。结局包括评估所有纳入患者的主要不良心血管事件（MACE）、非致死性心肌梗死（MI）、心源性死亡、靶血管血运重建（TVR）、肌痛/肌无力以及丙氨酸氨基转移酶（ALT）异常。应用随机效应模型和固定效应模型合并数据，并通过 检验和 检验进行进一步分析。然后通过相对危险度（RR）及其95%置信区间（95%CI）分析主要结局。
纳入11项研究，共3123例个体。与术前接受安慰剂或未接受他汀治疗的患者相比，强化他汀治疗与MACE风险的明显降低相关（RR = 0.44，95%CI：0.31 - 0.61，<0.00001）。然而，与术前接受中等强度他汀治疗的患者相比，强化他汀治疗未见优势（RR = 1.04，95%CI：0.82 - 1.31， = 0.74）。此外，除了非致死性MI（RR = 0.54，95%CI：0.33 - 0.88， = 0.01）外，强化他汀治疗与非强化他汀治疗在TVR发生率（RR = 0.43，95%CI：0.18 - 1.02， = 0.06）、肌痛/肌无力（RR = 1.35，95%CI：0.30 - 5.95， = 0.69）和ALT异常（RR = 1.47，95%CI：0.54 - 4.02， = 0.45）方面未观察到显著差异。
与安慰剂或未进行他汀预处理相比，PCI前强化他汀治疗可降低MACE发生率。然而，高强度和中等强度他汀之间无显著获益。此外，除了非致死性MI外，强化他汀治疗与非强化他汀治疗在TVR、肌痛/肌无力和ALT异常发生率方面未观察到显著差异。
