engleski

THE ROLE OF EARLY HIGH-DOSE ROSUVASTATIN LOADING IN PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROMES WITHOUT PERSISTENT ST- SEGMENT ELEVATION

Objectives: The present study aimed to examine the impact of early high-dose rosuvastatin loading (pretreatment) vs. no loading or placebo on short-term adverse outcomes at 30 days in statin-naive patients with acute coronary syndromes without persistent ST- segment elevation (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Patients and methods: Quantitative analysis and meta-analysis were performed by including five randomized controlled trials (RCTs) that examined the use of rosuvastatin in NSTE-ACS patients undergoing PCI. Primary outcomes of interest were outcomes at 30 days including major adverse cerebrovascular and cardiovascular events (MACCE), myocardial infarction (MI), and all-cause death. Secondarily, we sought to determine the impact of the same intervention on MACCE in patients with NSTE-ACS of whom all received PCI. Odds ratio (OR) with 95% confidence intervals (95% CI) was used as the main summary measure while a random-effects model with the Mantel-Haenszel method was used for the meta-analysis. Results: A total of 5 RCTs enrolling 1300 patients contributed to observed effect estimates. More than two-thirds of patients were male with a mean age of 63±11 years. Both rosuvastatin loading and control cohorts were generally well-balanced concerning baseline comorbidities, angiographic disease burden, and concomitant cardiovascular pharmacotherapy. Early high-dose rosuvastatin loading, compared to no loading or placebo, was associated with a significant reduction in the likelihood of MACCE (OR 0.41, 95% CI 0.27-0.60 ; P<0.001) and myocardial infarction (OR 0.44, 95% CI 0.29- 0.67 ; P<0.001) without significant impact in reduction of all-cause mortality (OR 0.44, 95% CI 0.09-2.03 ; P=0.290). Finally, in trials in which all NSTE-ACS patients received PCI, rosuvastatin loading was associated with a 62% reduction in the likelihood of MACCE at 30 days (OR 0.38, 95% CI 0.25-0.57 ; P<0.001). Conclusion: Early high-dose rosuvastatin loading strategy was associated with a significant reduction of MACCE and recurrent MIs among statin-naive patients with NSTE-ACS undergoing PCI. Rosuvastatin loading did not affect short-term mortality in this setting.

Acute coronary syndrome ; Non-ST Elevated Myocardial Infarction ; Unstable Angina ; Rosuvastatin, Treatment Outcome ; Systematic Reviews as Topic, Statins ; NSTE-ACS ; Rosuvastatin ; Preloading ; Loading ; Pretreatment

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