TCT.18: Pre-PCI statin dose slashes MACE by 28%

Acute coronary syndrome patients who were given a loading dose of atorvastatin before percutaneous coronary intervention (PCI) experienced a 28 percent reduction in major adverse cardiovascular events (MACE) over the following 30 days, according to a secondary analysis of the randomized SECURE-PCI trial published in JAMA Cardiology.

The risk reduction was consistent regardless of the timing of the loading dose and was particularly pronounced among patients with ST-segment elevation myocardial infarction (STEMI), who saw a 41 percent relative reduction in events compared to those with non-STEMI acute coronary syndromes (ACS).

“Considering the relative safety of atorvastatin, treating ACS patients—and especially those with STEMI—as early as possible before PCI is a reasonable approach and may improve short-term clinical outcomes,” lead author Renato D. Lopes, MD, PhD, with the Brazilian Clinical Research Institute and the Duke Clinical Research Institute, said while presenting the results at the Transcatheter Cardiovascular Therapeutics conference in San Diego.

The analysis featured 2,710 patients who underwent PCI from the SECURE-PCI trial, representing 64.7 percent of the initial cohort. Patients were randomized to either two loading doses of 80 mg of atorvastatin or a matching placebo before and 24 hours after a PCI. Participants in both groups received 40 mg of atorvastatin for 30 days beginning a day after administration of the second dose of the study drug (or placebo).

The occurrence of MACE—a composite of all-cause mortality, acute MI, stroke and unplanned coronary revascularization—was 6.0 percent in the treatment group and 8.2 percent in the placebo group. Each component of the endpoint was numerically reduced in the intervention arm, and there was a relative 32 percent reduction in MI.

“It’s likely that this is not due to lipid-lowering and probably it’s related to the pleiotropic effects, and that includes effects against inflammation and an antithrombotic effect,” Lopes said. “I think one of the key messages is because we’re going to have to give statins no matter what in some high-risk patients, why not just give it up front and potentially save the events with the 30-day follow up.”