Effect of preprocedural statin use on procedural myocardial infarction and major cardiac adverse events in percutaneous coronary intervention: A meta-analysis

BACKGROUND: Multiple primary and secondary prevention trials demonstrate significant reduction in adverse cardiovascular outcomes in patients with, or at risk of, coronary artery disease as a result of statin therapy. This study was conducted to determine whether statin use prior to elective percutaneous coronary intervention (PCI) is associated with lower procedural myocardial infarction (MI) and major adverse cardiovascular events (MACE) in the form of a meta-analysis. METHODS: Trials were eligible for inclusion if they included patients who received a statin prior to PCI and if appropriate documentation of procedural MI was performed. Studies that included acute coronary syndrome patients were excluded. For each trial, the results immediately post intervention and at the longest follow up (up to 12 months) were extracted and analyzed based on an intention-to-treat principle. Six trials involving 2,996 subjects met the inclusion criteria for periprocedural MI and were included in the analysis. Three trials involving 6,723 subjects had appropriate follow up and were analyzed for MACE (the combined endpoint of death, nonfatal MI or target vessel revascularization) up to 12 months after PCI. RESULTS: When the 6 trials included in the main analysis were combined, the summary effect of statins on reducing procedural MI was -5.44% (95% CI -8.2% to -2.7% [p < 0.0001]). There was no evidence of heterogeneity between trials (p = 0.66). The relative risk reduction was 59.3% (9.17% vs. 3.73%; p < 0.001). Sensitivity analysis did not alter this finding. The MACE rates were 19.5% and 15.5% in the control and statin groups, respectively. The overall MACE risk difference was -4.0%, (95% CI -11.4% to +3.4% [p = 0.2900]). The corresponding overall relative risk reduction was 20.5%.