Takeaway
- 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).
Limitations
- Heterogeneity between studies.
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