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
ARTICLE HIGHLIGHTS
Research background

At present, the burden of cardiovascular and cerebrovascular disease is very heavy in China. Despite the rapid development of percutaneous coronary intervention (PCI), the overall mortality rate of coronary heart disease and acute myocardial infarction in China is still on the rise. This suggests that there is room for optimizing perioperative therapy.

Research motivation

In China, patients with acute coronary syndrome regularly received intensive statin (such as atorvastatin 40 mg/d or rosuvastatin 20 mg/d) after PCI. Because of the very limited data, the guidelines do not give a positive recommendation for preoperative intensity statin therapy, which was inconsistent with Western people. As members of the medical team in a Coronary Care Unit, we are eager to know if intensive statin before PCI can benefit Chinese patients.

Research objectives

To evaluate the efficacy and safety of intensive statin therapy as compared to non-intensive statin pretreatment before PCI in the Chinese population through a meta-analysis investigation.

Research 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 events, non-fatal myocardial infarction, cardiac death, target vessel revascularization, myalgia/myasthenia and abnormal alanine aminotransferase 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.

Research results

Compared with patients receiving placebo or no statin treatment before surgery, intensive statin treatment was associated with a clear reduction of risk of major adverse cardiovascular events [risk ratio (RR) = 0.44, 95% confidence interval (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 target vessel revascularization (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 myocardial infarction (RR = 0.54, 95%CI: 0.33-0.88, P = 0.01).

Research conclusions

Our finding was significant that when compared with placebo or no statin pretreatment, intensive statin before PCI displayed reduced incidence of major adverse cardiovascular events. However, there was no significant benefit between high and moderate-intensity statin.

Research perspectives

It is likely to promote at least the use of moderate-intensity statin before PCI instead of no statin pretreatment in Chinese patients.