High-dose statin loading prior to PCI in STEMI patients improved post-PCI TIMI flow 3 (OR 2.08; 95% CI 1.28-3.38) and reduced 30-day MACE (OR 0.55; 95% CI 0.37-0.82).
Meta-Analysis (n=1,599)
Does high-dose statin loading prior to PCI improve post-PCI TIMI flow 3 and reduce 30-day MACE in STEMI patients?
High-dose statin loading prior to primary PCI in STEMI patients significantly improves post-procedural coronary blood flow and reduces short-term major adverse cardiovascular events.
Odds Ratio: 2.08 (95% CI 1.28–3.38)
p-value: p=0.63
Abstract Background Acute ST-Elevation Myocardial Infarction (STEMI) is a medical emergency that requires prompt reperfusion therapy. Although percutaneous coronary intervention (PCI) is recognized as the standard treatment, the periprocedural pharmacological management of STEMI remains a topic of debate, with potential for improvement. Several observational studies and randomized clinical trials (RCTs) on patients with STEMI suggest that prior high-dose statin loading may enhance coronary blood flow, evidenced by the Thrombolysis In Myocardial Infarction (TIMI) frame count after PCI, and is also associated with improved short-term clinical outcomes. Purpose Conduct a Systematic Review and Meta-Analysis to evaluate the efficacy of high-dose statin loading in STEMI patients undergoing PCI. Methods We systematically searched the Cochrane Controlled Register of Trials, EMBASE, and PubMed for RCTs. The primary outcome was post-PCI TIMI flow 3, while the secondary endpoint was a composite of 30-day Major Adverse Cardiovascular Events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke within 30 days. Loading strategies of 40-80 mg of atorvastatin or 20-40 mg of rosuvastatin were admitted. We pooled dichotomous data using odds ratios (OR) to describe effect sizes, employing a Mantel-Haenszel procedure in a random-effects model, with a 95% confidence interval. Heterogeneity was assessed statistically using the I² index (25% low, 25%-50% moderate, 50% high heterogeneity). Results Of the 1,085 records identified, six studies were included, providing data on a total of 1,599 patients. Our meta-analysis revealed a higher incidence of post-PCI TIMI flow 3 in the high-dose statin group (pooled OR 2.08 1.28, 3.38, P=0.63, I²=0). Additionally, the experimental strategy demonstrated a lower rate of 30-day MACE (pooled OR 0.55 0.37, 0.82, P=0.55; I²=0%). Although we included only RCTs, we acknowledge that the outcomes analyzed in our meta-analysis may encompass endpoints that were not utilized for calculating the sample size. Conclusions Our results indicate that high-dose statin loading prior to PCI in STEMI patients is associated with a significant improvement in post-PCI TIMI flow 3 and a reduction in the incidence of 30-day MACE. These findings support the clinical benefit of implementing high-dose statin loading in the acute management of STEMI. Therefore, we consider that further research is warranted with larger-scale RCTs.
Resende et al. (Sat,) conducted a meta-analysis in Acute ST-Elevation Myocardial Infarction (STEMI) (n=1,599). High-dose statin loading was evaluated on post-PCI TIMI flow 3 (OR 2.08, 95% CI 1.28, 3.38, p=0.63). High-dose statin loading prior to PCI in STEMI patients improved post-PCI TIMI flow 3 (OR 2.08; 95% CI 1.28-3.38) and reduced 30-day MACE (OR 0.55; 95% CI 0.37-0.82).