Effect of loading dose of atorvastatin therapy prior to percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of six randomized controlled trials

Mingfeng Ma,1,2 Lixia Bu,3 Li Shi,1 Renwei Guo,3 Bin Yang,2 Huili Cao,2 Liangping Luo,4 Ligong Lu5 1Department of Cardiology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, Guangdong 519000, People’s Republic of China; 2Department of Cardiovascular Medicine, Second Hospital of Shanxi University, Taiyuan, Shanxi 030001, People’s Republic of China; 3Department of Neurology, Fenyang Hospital of Shanxi Province, Fenyang, Shanxi 032200, People’s Republic of China; 4Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, People’s Republic of China; 5Center of Intervention Radiology, Zhuhai Precision Medicine Center, Zhuhai People’s Hospital, Zhuhai, Guangdong 519000, People’s Republic of China Purpose: The study sought to summarize the evidence of pre-procedural atorvastatin therapy to improve the prognosis of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Patients and methods: We searched PubMed and Embase from inception to July 2018 for randomized controlled trials that compared loading dose atorvastatin pretreatment with no or low dose for the prevention of cardiovascular events. The primary end points were all-cause mortality and myocardial infarction (MI) at 30 days. The secondary end point was 30-day major adverse cardiovascular events (MACE), a composite of all-cause mortality, MI, and revascularization. Results: Six trials with 4,991 individuals were included in our meta-analysis. High-dose atorvastatin preloading before PCI was associated with a 27% relative reduction in MI (OR: 0.73, 95% CI, 0.56–0.94, P=0.015). All-cause mortality was nonsignificantly reduced by early treatment with high-potency atorvastatin (OR: 0.94, 95% CI, 0.69–1.30, P=0.725). There was a 20% reduction in MACE in the group of patients treated with statin loading prior to PCI (OR: 0.80, 95% CI, 0.66–0.97, P=0.026). When stratified according to the diagnosis of ACS, the results of MACE were only significant for those ST-elevation myocardial infarction patients undergoing PCI (OR: 0.67, 95% CI, 0.48–0.94, P=0.022) and were not noted in the group of non-ST elevation ACS patients (OR: 0.65, 95% CI, 0.35–1.22, P=0.179). Conclusion: High-dose atorvastatin pretreatment leads to a significant reduction in MI and MACE at 30 days in ACS patients undergoing PCI, especially in ST-segment elevation MI. Keywords: atorvastatin, acute coronary syndrome, percutaneous coronary intervention, adverse events