Coronary artery disease
Usefulness of Statin Pretreatment to Prevent Contrast-Induced Nephropathy and to Improve Long-Term Outcome in Patients Undergoing Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2007.08.030Get rights and content

Contrast-induced nephropathy (CIN) is an important cause of mortality and morbidity in patients undergoing angiography. This study investigated whether statins decrease incidence of CIN in the setting of percutaneous coronary intervention (PCI) and evaluated the influence of such potential benefit on long-term outcome. Four-hundred thirty-four patients undergoing PCI were prospectively enrolled and followed up to 4 years. Patients were stratified according to preprocedural statin therapy (260 statin treated, 174 statin naive). CIN was defined as a postprocedural increase in serum creatinine of ≥0.5 mg/dl or >25% from baseline. Follow-up assessment included 4-year occurrence of major adverse cardiac events. Statin-treated patients had a significantly lower incidence of CIN (3% vs 27%, p <0.0001; 90% risk decrease) and had better postprocedural creatinine clearance (80 ± 20 vs 65 ± 16 ml/min, p <0.0001). Benefit of statin before treatment was observed in all subgroups, except in patients with a pre-existing creatinine clearance <40 ml/min. During follow-up, CIN was a predictor of poorer outcome; 4-year survival free of major adverse cardiac events was highest in statin-treated patients without CIN (95%, p ≤0.015) and lowest in statin-naive patients with CIN (53%, p ≤0.018). In conclusion, patients receiving statins before PCI have a significant decrease of CIN; this early protective effect translates into better long-term event-free survival. These results may lend further support to utilization of statins as adjuvant pharmacologic therapy before PCI.

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Methods

Four-hundred eighty consecutive patients undergoing PCI at Campus Bio-Medico University of Rome from June 1, 2000 to June 1, 2001 were evaluated (Figure 1). Patients had signs and/or symptoms of myocardial ischemia and angiographic evidence of significant coronary disease warranting PCI. To minimize the potential role of hemodynamic instability as a cause of postprocedural renal failure, 46 patients with ST-segment elevation acute myocardial infarction <48 hours, cardiogenic shock, or left

Results

In the statin-treated group, 153 patients (59%) were taking atorvastatin, 77 (30%) simvastatin, 19 (7%) rosuvastatin, and 11 (4%) pravastatin; mean duration of statin pretreatment was 10.6 ± 9.1 months. Clinical and procedural characteristics are listed in Table 1, Table 2, respectively. Statin-treated patients were younger and had higher prevalences of hypercholesterolemia, acute coronary syndromes on presentation, previous coronary revascularization, more complex lesions (B2 and C), and more

Discussion

This study indicates that patients receiving statin treatment before PCI have a decreased incidence of postprocedural CIN compared with patients not receiving statins; this benefit is associated with improved long-term clinical outcome, including a significant decrease in cardiac death at 4 years.

Chronic renal failure worsens prognosis in patients with coronary artery disease and in those undergoing coronary angioplasty,12, 13 and development of CIN after PCI correlates with increased risk of

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