High-dose atorvastatin before percutaneous coronary intervention improves outcomes in acute coronary syndrome

  • Ma Y & al.
  • Med Sci Monit
  • 23 Dec 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • In a meta-analysis, high-dose atorvastatin pre-treatment was associated with significant reduction in short-term major adverse cardiac events (MACEs) and serum high-sensitivity C-reactive protein (hs-CRP) levels in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
  • High-dose atorvastatin did not increase serum alanine aminotransferase levels.

Why this matters

  • Larger trials with longer follow-up duration are required to confirm the clinical benefits of high-dose atorvastatin loading in patients with ACS who undergo primary PCI.

Study design              

  • Meta-analysis of 17 randomised controlled trials identified after a search on PubMed, EMBASE, Cochrane CENTRAL and Web of Science databases until May 2018.
  • 10,072 patients with ACS who underwent PCI received either high-dose atorvastatin or low-dose atorvastatin/placebo (control group).
  • Funding: No external funding.

Key results                                                                                                       

  • Compared with low-dose atorvastatin or placebo, high-dose atorvastatin preloading was associated with greater reduction in:
    • short-term MACEs (9 studies; OR, 0.72; P=.01) and
    • hs-CRP level (9 studies; standardised mean difference [SMD], –1.59; P<.0001>
  • No significant difference was observed between 2 groups in:
    • peak creatine kinase-myocardial band levels (6 studies; SMD, –0.34; P=.13) and
    • thrombolysis in myocardial infarction grade 3 flow (7 studies; pooled OR, 1.31; P=.36).
  • High-dose atorvastatin therapy was not associated with serum alanine aminotransferase elevation compared with the controlled group (4 studies; pooled OR, 1.95; P=.07).


  • Heterogeneity between studies.