Abstract
Background: Studies of intensive statin pretreatment before percutaneous coronary intervention (PCI) was very limited in Chinese and there were no corresponding meta-analysis involving hard clinical endpoints has been published so far. Therefore, the guidelines did not give a positive recommendation, which was inconsistent with Western people. The aim of this study was to evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through meta-analysis.Method: Relevant studies were identified via search of electronic databases of PubMed, Embase, and Cochrane’s Library to December 2019. The outcomes included major adverse cardiovascular event (MACE), nonfatal myocardial infarction(MI), cardiac death, target vessel revascularization (TVR), myalgia/myasthenia and abnormal alanine aminotransferase (ALT) in all enrolled patients were assessed.Results: 12 studies involving 3183 individuals were included in this review．The results showed different from cardiac death and TVR, the incidence of MACE ( RR =0.49, 95% CI : 0.30 to 0.80, P =0.004, I 2 =63%) and nonfatal MI ( RR =0.54, 95% CI : 0.33~ 0.88, P = 0.01, I 2 =62%) between intensive statin and non-intensive statin treatment group were statistically significant. The subgroup analysis further suggested the benefits of different treatment were not consistent. Compared with the preoperative intensive statin therapy, the incidence of MACE and nonfatal MI were significantly elevated in patients receiving placebo or no statin treatment before surgery（ RR =0.47, 95% CI : 0.34～0.65, P <0.00001, I 2 =0%; RR =0.49, 95% CI : 0.35～0.70, P <0.0001, I 2 =0%）. However, the incidence of MACE and nonfatal MI were not statistically significant compared preoperative high-intensity statin therapy with moderate-intensity statin therapy（ RR =0.96, 95% CI : 0.44～2.08, P =0.91, I 2 =11%; RR =1.10, 95% CI : 0.86～1.39, P =0.44）. Besides, The study also demonstrated Asian population were able to tolerate high-intensity atorvastatin during the perioperative period.Conclusion: Compared with placebo or no statin pretreatment, Chinese patients received intensive statin before PCI can further reduce the incidence of MACE and nonfatal myocardial infarction. However there was no significant benefit between high-intensity and moderate-intensity statin. In addition, the Chinese population was well tolerated by preoperative intensive statin pretretment.
Comparing High-Intensity Versus Low-to Moderate-Intensity Statin Therapy in Korean Patients with Acute Myocardial Infarction