Document Detail

Evidence of pre-procedural statin therapy a meta-analysis of randomized trials.
MedLine Citation:
PMID:  20825761     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. BACKGROUND: Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction (MI) and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. METHODS: We searched the MEDLINE, Cochrane, and databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. RESULTS: Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural MI (risk ratio [RR]: 0.57, 95% confidence interval [CI]: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (RR: 0.66, 95% CI: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (RR: 0.54, 95% CI: 0.43 to 0.68, p < 0.0001). CONCLUSIONS: Statins administered before invasive procedures significantly reduce the hazard of post-procedural MI. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered.
David E Winchester; Xuerong Wen; Lola Xie; Anthony A Bavry
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2010-08-31
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2010-10-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1099-109     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
University of Florida, Gainesville, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  methods*,  mortality
Atrial Fibrillation / mortality,  prevention & control
Coronary Artery Bypass / adverse effects,  methods*,  mortality
Evidence-Based Medicine
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Myocardial Infarction / mortality*,  surgery*,  therapy
Postoperative Complications / mortality,  prevention & control
Preoperative Care / methods
Randomized Controlled Trials as Topic
Recurrence / prevention & control
Risk Assessment
Surgical Procedures, Operative
Survival Analysis
Treatment Outcome
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comment In:
J Am Coll Cardiol. 2010 Sep 28;56(14):1110-2   [PMID:  20825762 ]

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