Key result
High-dose rosuvastatin matches atorvastatin for 1-year MACE after PCI.
Why the study?
There was a lack of conclusive evidence from the developing world regarding the safety, tolerability, and comparative effectiveness of high-dose Rosuvastatin versus Atorvastatin in post-PCI patients.
Does high-dose rosuvastatin (40 mg/day) improve clinical outcomes, safety, and tolerability compared to high-dose atorvastatin (80 mg/day) in post-PCI patients?
Cohort (n=942)
No
Does high-dose rosuvastatin (40 mg/day) improve clinical outcomes, safety, and tolerability compared to high-dose atorvastatin (80 mg/day) in post-PCI patients?
Odds Ratio: 1.08 (95% CI 0.5–2.34)
Absolute Event Rate: 3.38% vs 3.12%
p-value: p=0.8445
High-dose atorvastatin (80 mg/day) appears to offer better hs-CRP control and gastrointestinal tolerability than high-dose rosuvastatin (40 mg/day) in post-PCI patients, with similar overall clinical efficacy.
Atorvastatin linked to better hs-CRP control and tolerability than rosuvastatin post-PCI; leaves open whether differences warrant preference pending randomized confirmation.
INTRODUCTION: Atorvastatin-80mg/day and Rosuvastatin-40mg/day are the commonest high-dose statin (3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors) regimes for post-PCI (Percutaneous Coronary Interventions) patients to lower (by ≥50%) blood low-density-lipoprotein cholesterol (LDL-C). Dearth of conclusive evidence from developing world, regarding overall safety, tolerability and comparative effectiveness (outcome/safety/tolerability/endothelial inflammation control) of Rosuvastatin over Atorvastatin in high-dose, given its higher cost, called for an overall and comparative assessment among post-PCI patients in a tertiary cardiac-care hospital of Kolkata, India. METHODS: A record-based non-concurrent cohort study was conducted involving 942 post-PCI patients, aged 18-75 years, on high-dose statin for three months and followed up for ≥one year. Those on Atorvastatin-80mg (n = 321) and Rosuvastatin-40mg (n = 621) were compared regarding outcome (death/non-fatal myocardial infarction: MI/repeated hospitalization/target-vessel revascularisation/control of LDL and high-sensitivity C-reactive protein: hsCRP), safety (transaminitis/myopathy/myalgia/myositis/rhabdomyolysis), tolerability (gastroesophageal reflux disease: GERD/gastritis) and inflammation control adjusting for socio-demographics, tobacco-use, medications and comorbidities using SAS-9.4. RESULTS: Groups varied minimally regarding distribution of age/gender/tobacco-use/medication/comorbidity/baseline (pre-PCI) LDL and hs-CRP level. During one-year post-PCI follow up, none died. One acute MI and two target vessel revascularizations occurred per group. Repeated hospitalization for angina/stroke was 2.18% in Atorvastatin group vs. 2.90% in Rosuvastatin group. At three-months follow up, GERD/Gastritis (2.18% vs 4.83%), uncontrolled hs-CRP (22.74% vs 31.08%) and overall non-tolerability (4.67% vs. 8.21%) were lower for Atorvastatin group. Multiple logistic regression did show that compared to Atorvastatin-80mg, Rosuvastatin-40mg regime had poorer control of hs-CRP (A3OR = 1.45,p = 0.0202), higher (A3OR = 2.07) adverse effects, poorer safety profile (A3OR = 1.23), higher GERD/Gastritis (A3OR = 1.50) and poorer overall tolerability (A3OR = 1.50). CONCLUSION: Post-PCI high dose statins were effective, safe and well-tolerated. High dose Rosuvastatin as compared to high dose Atorvastatin were similar in their clinical efficacy. Patients treated with Atrovastatin had significantly lower number of patients with hs-CRP (high-sensitivity C-reactive protein)/C-reactive protein (CRP) level beyond comparable safe limit and relatively better tolerated as opposed to Rosuvastatin-40mg.Thus given the lower price, Atorvastatin 80mg/day appeared to be more cost-effective. A head-to-head cost-effectiveness as well as efficacy trial may be the need of the hour.
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Roy et al. (2020) conducted a cohort in Post-percutaneous coronary intervention (PCI) (n=942). Rosuvastatin vs. Atorvastatin 80 mg/day was evaluated on Composite primary outcome of major adverse cardiac events (death, non-fatal MI, repeated hospitalization for angina/stroke, target vessel revascularization) (OR 1.08, 95% CI 0.50-2.34, p=0.8445). High-dose Rosuvastatin (40 mg) and Atorvastatin (80 mg) demonstrated similar rates of the composite primary outcome of major adverse cardiac events at one year post-PCI (3.38% vs 3.12%; OR 1.08).
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