Abstract 3074: Benefit of Statin Therapy for Percutaneous Coronary Intervention: A Meta-Analysis
Introduction: The benefit of statin therapy initiated for routine percutaneous coronary intervention (PCI) on adverse cardiovascular outcomes is unknown.
Hypothesis: Accordingly, we sought to evaluate the impact of statin therapy initiated around the time of PCI on individual cardiac outcomes.
Methods: We conducted a meta-analysis on randomized trials where statin therapy was administered either early before or after PCI. Studies were included if patients were randomized to aggressive statin or conservative therapy (placebo/ usual care) and outcome data were available. We calculated risk ratios (RR) and 95% confidence intervals (CI) for all-cause mortality, cardiovascular mortality, myocardial infarction, stroke and revascularization.
Results: In all, there were 6 studies available for analysis (PREDICT, FLARE, LIPS, GAIN, ARMYDA and Brigouri et al) that randomized 3,941 patients (aggressive=1,967 and placebo=1,974). The range of statin initiation ranged from 15 days prior to 2 days after PCI. Clinical follow up ranged from 1 day to 45 months. The incidence of all-cause mortality was 2.2% versus 2.9% in the aggressive versus placebo arms, (RR=0.74, 95%CI 0.50 to 1.1, p=0.14) while the incidence of cardiovascular mortality was 0.71% and 1.2% respectively, (RR=0.58, 95%CI 0.30 to1.11, p=0.102). The incidence of myocardial infarction was 3.0% and 5.2%, respectively (RR=0.57, 95%CI 0.42 to 0.78, p<0.0001). The incidence of revascularization was marginally reduced in the aggressively treated arms, 1.7% versus 1.9% (RR=0.89, 95%CI 0.78 to 1.02, p=0.098). However, the incidence of stroke was 0.25% versus 0.051% (RR=3.00, 95%CI 0.60 to 14.77, p=0.18).
Conclusions: Statin therapy initiated early before or after PCI results in a significant reduction in myocardial infarction during the course of follow-up.