Early statins may lower risk of post-procedure kidney injury

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Patients with acute coronary syndrome (ACS) who use rosuvastatin may lower their risk of post-procedure contrast-induced kidney injury (CI-AKI), according to a study published online Oct. 9 in Journal of the American College of Cardiology. Significantly fewer patients who took the statin drug developed CI-AKI compared with patients who did not receive the drug.

The Protective effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome (PRATO-ACS) study sought to determine whether rosuvastatin (Crestor, AstraZeneca) administered at the time of admission protected against CI-AKI I patients with ACS without ST-segment elevation (NSTE-ACS).

Mario Leoncini, MD, of Misericordia e Dolce Hospital in Prato, Italy and his colleagues enrolled 543 NSTE-ACS patients admitted to the hospital between 2010 and 2012. None of the patients ever received statins before. They were randomized to a control group and an experimental group that received rosuvastatin. A total of 504 participants remained after randomization.

“On-admission high-dose rosuvastatin in statin-naïve patients with ACS scheduled for early invasive procedure can prevent CI-AKI and improve short-term clinical outcome,” the authors wrote.

Patients in the statin group received an initial dose of 40 mg of rosuvastatin and then a 20 mg daily dose. After discharge, the patients in the experimental group continued their 20 mg daily dose of rosuvastatin (10 mg per day for patients with a low glomerular filtration rate). The control group patients received 40 mg a day of atorvastatin (Lipitor, Pfizer).

The main study outcome was CI-AKI, which the authors defined as a creatinine level of 0.5 mg/dL or higher or an increase of 25 percent or more above baseline within three days of receiving contrast. Additional endpoints included other definitions of CI-AKI, CI-AKI incidence in certain risk groups, adverse cardiovascular and renal events 30 days later and all-cause mortality or the rate of non-fatal myocardial infarction (MI) six months later.

CI-AKI occurred significantly less often in the experimental group than in the control group (6.7 percent vs 15.1 percent), even when using alternate defining criteria for CI-AKI and in all the risk subgroups. Adverse cardiovascular and renal events as well as all-cause mortality and non-fatal MI were all significantly less frequent in the statin group.

Previous studies have also pointed to the protective benefits of statins on the heart and kidneys in patients with ACS, the authors wrote.

“It remains to be established if reloading with high-dose statin may augment renal protection also in ACS patients on chronic statin therapy,” they concluded.