Key result
High-dose atorvastatin pre-loading before PCI significantly reduced MACE at one month (RR 0.78; 95% CI 0.67-0.91; p=0.014) in patients with STEMI and NSTEMI.
Why the study?
It remained uncertain whether high-dose atorvastatin provides the same short- and long-term protective effects in patients undergoing PCI as seen in long-term secondary prevention.
Does high-dose atorvastatin pre-loading reduce MACE in adult patients with STEMI or NSTEMI undergoing PCI?
Meta-Analysis (n=5,399)
Does high-dose atorvastatin pre-loading reduce MACE in adult patients with STEMI or NSTEMI undergoing PCI?
Relative Risk: 0.78 (95% CI 0.67–0.91)
p-value: p=0.014
High-dose atorvastatin pre-loading before PCI significantly reduces 30-day MACE in patients with STEMI or NSTEMI and all-cause mortality in STEMI patients.
Supports early high-dose atorvastatin peri-PCI in MI; extends short-term MACE reduction evidence while leaving sustained benefit open.
Atorvastatin is widely recommended for long-term secondary prevention in STEMI patients with no contraindication. Although high-dose atorvastatin has been shown to reduce important patient outcomes such as MACE, there is still doubt that high-dose atorvastatin could have the same protective effect in patients undergoing PCI in the short and long term. We searched the following electronic databases: Scopus, Web of Science, MEDLINE, EMBASE, and Cochrane Central considering studies that enrolled adult patients with a confirmed diagnosis of STEMI or NSTEMI undergoing PCI. The intervention must have been atorvastatin alone compared to a placebo, standard care, or a different atorvastatin dose. A total of (n = 11) studies were included in the quantitative analysis. Information on (N = 5,399) patients was available; 2,654 were assigned to receive high-dose atorvastatin therapy, and 2,745 comprised the control group. High-dose atorvastatin pre-loading significantly reduced MACE at one month of follow-up (RR: 0.78; 95% CI: 0.67-0.91; p = 0.014) in both STEMI and NSTEMI. All-cause mortality was reduced in patients with STEMI (RR: 0.28; 95% CI: 0.10-0.81; p = 0.029). The quality of the body of evidence was rated overall as moderate. Patients presenting with STEMI or NSTEMI benefit from high-dose atorvastatin pre-loading before PCI by reducing MACE at 30 days. The use of high-dose atorvastatin in STEMI patients reduced all-cause mortality. The beneficial effects of atorvastatin pre-loading are limited to 30 days post-PCI.
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García-Campa et al. (2024) conducted a meta-analysis in STEMI or NSTEMI undergoing PCI (n=5,399). Atorvastatin pre-loading vs. Placebo, standard care, or a different atorvastatin dose was evaluated on MACE at one month (RR 0.78, 95% CI 0.67-0.91, p=0.014). High-dose atorvastatin pre-loading before PCI significantly reduced MACE at one month (RR 0.78; 95% CI 0.67-0.91; p=0.014) in patients with STEMI and NSTEMI.
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