Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1557-1571
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1557
Intensive vs non-intensive statin pretreatment before percutaneous coronary intervention in Chinese patients: A meta-analysis of randomized controlled trials
Xian Yang, Xi Lan, Xin-Lin Zhang, Zhong-Lin Han, Si-Min Yan, Wen-Xiao Wang, Biao Xu, Wei-Hong Ge
Xian Yang, Si-Min Yan, Wei-Hong Ge, Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Xian Yang, Si-Min Yan, Wei-Hong Ge, Department of Pharmacy, Nanjing Medical Center for Clinical Pharmacy, Nanjing 210000, Jiangsu Province, China
Xi Lan, Xin-Lin Zhang, Zhong-Lin Han, Biao Xu, Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, Jiangsu Province, China
Wen-Xiao Wang, Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Ge WH and Xu B designed the research; Yang X, Lan X, Zhang XL and Yan SM collected the data; Lan X and Zhang XL analyzed the data; Yang X and Lan X supervised the research; Yang X, Lan X, Zhang XL, Han ZL and Wang WX wrote the paper.
Supported by the Scientific Research Project of Nanjing Clinical Medical Centre, No. 1 Ning Health Science Education [2020].
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Hong Ge, MS, Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Gulou District, Nanjing 210000, Jiangsu Province, China. wh.ge.drumtower@outlook.com
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: October 20, 2021
Revised: November 9, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: February 16, 2022
Processing time: 183 Days and 3.7 Hours
Abstract
BACKGROUND

The results of intensive statin pretreatment before percutaneous coronary intervention (PCI) is inconsistent between Chinese and Western populations, and there are no corresponding meta-analyses involving hard clinical endpoints in the available published literature.

AIM

To evaluate the efficacy and safety of high-dose statin loading before PCI in Chinese patients through a meta-analysis.

METHODS

Relevant studies were identified by searching the electronic databases of PubMed, Embase and Cochrane’s Library to December 2019. The outcomes included an assessment of major adverse cardiovascular event (MACE), non-fatal myocardial infarction (MI), cardiac death, target vessel revascularization (TVR), myalgia /myasthenia and abnormal alanine aminotransferase (ALT) in all enrolled patients. Random effect model and fixed effect model were applied to combine the data, which were further analyzed by χ2 test and I2 test. The main outcomes were then analyzed through the use of relative risks (RR) and its 95% confidence interval (95%CI).

RESULTS

Eleven studies involving 3123 individuals were included. Compared with patients receiving placebo or no statin treatment before surgery, intensive statin treatment was associated with a clear reduction of risk of MACE (RR = 0.44, 95%CI: 0.31-0.61, P < 0.00001). However, compared with the patients receiving moderate-intensity statin before surgery, no advantage to intensive statin treatment was seen (RR = 1.04, 95%CI: 0.82-1.31, P = 0.74). In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR (RR = 0.43, 95%CI: 0.18-1.02, P = 0.06) , myalgia /myasthenia (RR = 1.35, 95%CI: 0.30-5.95, P = 0.69) and abnormal alanine aminotransferase (RR = 1.47, 95%CI: 0.54-4.02, P = 0.45) except non-fatal MI (RR = 0.54, 95%CI: 0.33-0.88, P = 0.01).

CONCLUSION

Compared with placebo or no statin pretreatment, intensive statin before PCI displayed reduced incidence of MACE. However, there was no significant benefit between high and moderate-intensity statin. In addition, no significant difference was observed between intensive statin therapy and non-intensive statin therapy on the incidence of TVR, myalgia/myasthenia and abnormal alanine aminotransferase except non-fatal MI.

Keywords: Intensive; Non-intensive; Statin; Percutaneous coronary intervention; Chinese; Meta-analysis

Core Tip: As the cornerstone of primary and secondary prevention of arteriosclerotic cardiovascular disease, statins have been widely used in clinical practice. However, whether intensive statin therapy before percutaneous coronary intervention (PCI) could benefit the Chinese population remains debatable. A meta-analysis was performed to evaluate the efficacy and safety of the strategy. The results showed that compared with placebo or no statin pretreatment, Chinese patients receiving intensive statin therapy before PCI could further reduce the incidence of major adverse cardiovascular events. In addition, there was no significant benefit to using high-intensity and moderate-intensity statin therapy.