Key result
High-dose statin preloading before primary PCI in STEMI is linked to improved reperfusion and reduced mortality.
Why the study?
Does high-dose statin preloading improve post-PCI TIMI flow grade 3 in STEMI patients undergoing primary PCI?
Meta-Analysis (n=1,862)
Does high-dose statin preloading improve post-PCI TIMI flow grade 3 in STEMI patients undergoing primary PCI?
High-dose statin preloading before primary PCI in STEMI patients improves coronary reperfusion and reduces all-cause mortality, suggesting potential value despite its omission from recent guidelines.
May warrant high-dose statin preloading before primary PCI in STEMI; extends prior trial evidence with pooled data.
INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition needing urgent reperfusion, with better outcomes linked to optimal myocardial perfusion. Statins may reduce ischemia-reperfusion injury through pleiotropic effects. While the 2019 European Society of Cardiology (ESC) Dislipidemia Guidelines recommended high-intensity statins before percutaneous coronary intervention (PCI), this was not included in the 2023 ESC or 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS Guidelines. OBJECTIVE: To evaluate the effect of high-dose statin loading before primary PCI in improving coronary reperfusion and clinical outcomes in STEMI patients through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: On June 2025, CENTRAL, EMBASE, and PubMed were searched for RCTs comparing high-dose statin preloading with placebo or no statin in STEMI patients undergoing primary PCI. The primary outcome was post-PCI thrombolysis in myocardial infarction (TIMI) flow grade 3. Secondary outcomes included all-cause mortality and greater than or equal to 50% ST-segment resolution. Data were pooled using random-effects models, reporting odds ratios (OR) with 95% confidence intervals (CIs). RESULTS: Nine RCTs with 1862 patients were included. High-dose statin preloading significantly increased the likelihood of achieving post-PCI TIMI flow grade 3 (OR: 1.52, 95% CI: 1.06-2.20). It was also associated with a reduction in all-cause mortality (OR: 0.59, 95% CI: 0.36-0.98). No significant difference was observed in greater than or equal to 50% ST-segment resolution (OR: 1.04, 95% CI: 0.71-1.50). CONCLUSION: High-dose statin loading before primary PCI in STEMI patients seems to be associated with improved coronary reperfusion and reduced all-cause mortality. These findings offer timely and clinically relevant insight, reminding the cardiovascular community of the potential value of this therapeutic.
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Resende et al. (2026) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=1,862). High-dose statin preloading vs. placebo or no statin was evaluated on post-PCI thrombolysis in myocardial infarction (TIMI) flow grade 3 (OR 1.52, 95% CI 1.06-2.20). High-dose statin preloading before primary PCI in STEMI patients significantly increased the likelihood of achieving post-PCI TIMI flow grade 3 (OR 1.52; 95% CI 1.06-2.20).
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