Key result
Pre-procedural statin therapy significantly reduced post-procedural no-reflow by 4.2% in patients undergoing percutaneous coronary intervention (RR 0.56; 95% CI 0.35 to 0.90; P=0.016).
Why the study?
Does pre-procedural statin therapy reduce post-procedural myocardial no-reflow in patients undergoing PCI?
Meta-Analysis (n=3,086)
Does pre-procedural statin therapy reduce post-procedural myocardial no-reflow in patients undergoing PCI?
Relative Risk: 0.56 (95% CI 0.35–0.9)
Absolute Risk Reduction: 4.2%
p-value: p=0.016
Acute intensive statin therapy before PCI significantly reduces the risk of post-procedural no-reflow phenomenon.
Supports pre-PCI statin loading to reduce no-reflow in STEMI; reinforces meta-analytic evidence for routine use.
BACKGROUND: Successful revascularization of coronary artery disease, especially ST-elevation myocardial infarction (STEMI), does not always mean optimal myocardial reperfusion in a portion of patients because of no-reflow phenomenon. We hypothesized that statins might attenuate the incidence of myocardial no-reflow when used before percutaneous coronary intervention (PCI). The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce myocardial no-reflow after PCI. METHODS: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to October 2012 for clinical trials that examined statin therapy before PCI. We required that studies initiated statins before PCI and reported myocardial no-reflow. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS: In all, 7 studies with 3086 patients met our selection criteria. The use of pre-procedural statins significantly reduced post-procedural no-reflow by 4.2% in all PCI patients (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.35 to 0.90, P = 0.016), and attenuated by 5.0% in non-STEMI patients (RR 0.41, 95% CI 0.18 to 0.94, P = 0.035). This benefit was mainly observed in the early or acute intensive statin therapy populations (RR 0.43, 95% CI 0.26 to 0.71, P = 0.001). CONCLUSIONS: Acute intensive statin therapy before PCI significantly reduces the hazard of post-procedural no-reflow phenomenon. The routine use of statins before PCI should be considered.
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Li et al. (2013) conducted a meta-analysis in Coronary artery disease undergoing percutaneous coronary intervention (n=3,086). Pre-procedural statin therapy vs. Control was evaluated on Post-procedural no-reflow (RR 0.56, 95% CI 0.35 to 0.90, p=0.016). Pre-procedural statin therapy significantly reduced post-procedural no-reflow by 4.2% in patients undergoing percutaneous coronary intervention (RR 0.56; 95% CI 0.35 to 0.90; P=0.016).
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