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Cardiology Clinical Pharmacist, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond, VA
Associate Professor of Pharmacy and Medicine, School of Pharmacy, Virginia Commonwealth University
Reprints: Dr. Cahoon, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, 401 N. 12th St., PO Box 980042, Richmond, VA 23298, fax 804/225-3920, wcahoon{at}mcvh-vcu.edu
OBJECTIVE: To review the published literature regarding the effectiveness of preprocedural statin therapy for the prevention of cardiac events after percutaneous coronary intervention (PCI).
DATA SOURCES: Searches of MEDLINE (1966-May 2007) and Cochrane Database (1993-May 2007) were conducted using the search terms statins, HMG-CoA reductase inhibitors, percutaneous coronary intervention, and myocardial necrosis. Limits included articles written in English with human subjects. Additional data were identified through bibliographic reviews.
STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were evaluated. Trials and studies were eligible for inclusion if they evaluated the effectiveness of preprocedural statin therapy for the prevention of cardiac events after PCI.
DATA SYNTHESIS: Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) provide benefits relative to morbidity and mortality as primary and secondary prevention of cardiovascular events. In addition to lowering concentrations of low-density lipoprotein cholesterol, statins have documented pleiotropic effects including plaque stabilization as well as reductions in inflammation, platelet activation/adhesion, thrombosis, and oxidative stress. One retrospective analysis, 4 prospective observational studies, and 3 randomized controlled trials evaluating preprocedural statin therapy for the prevention of cardiac events after PCI were reviewed. Included studies were limited by small sample sizes (N = 153-5052), short durations of follow-up (24 h-21 mo), use of surrogate markers of myocardial necrosis, various degrees of coronary disease and procedure-specific factors, and lack of consistent choice of agent, dose, and duration of statin therapy. Despite these limitations, the data suggest reduced post-PCI myocardial necrosis with preprocedural statin therapy when given before elective PCI in stable patients, as well as when given before PCI in patients with recent acute coronary syndrome.
CONCLUSIONS: There is growing evidence that preprocedural statin therapy reduces the incidence of post-PCI myocardial necrosis. The appropriate regimen (drug, dose, duration of treatment before the procedure), as well as the predictive role of concomitant disease states (eg, hyperlipidemia), requires further investigation.
Key Words: HMG-CoA reductase inhibitors, myocardial infarction, myocardial necrosis, percutaneous coronary intervention
Published Online, August 21, 2007. www.theannals.com, DOI 10.1345/aph.1K248
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