A meta-analysis of randomized controlled trials on statins for the prevention of contrast-induced acute kidney injury in patients with and without acute coronary syndromes

作者：Marenzi Giancarlo^*; Cosentino Nicola; Werba Jose P; Tedesco Calogero C; Veglia Fabrizio; Bartorelli Antonio L

来源：International Journal of Cardiology, 2015, 183: 47-53.

DOI：10.1016/j.ijcard.2015.01.046

• Statins
• Contrast-induced acute kidney injury
• Coronary angiography
• Percutaneous coronary intervention
• Acute coronary syndromes

Objectives: We assessed whether short-term, pre-procedural, intensive statin treatment may reduce contrast-induced acute kidney injury (CI-AKI) incidence in patients with and without acute coronary syndromes (ACS) undergoing coronary angiography (CA) and percutaneous coronary intervention (PCI). Background: Statins may exert renal-protective effects through their pleiotropic properties. However, there have been conflicting reports on the CI-AKI preventive effect of pre-procedural statin administration.
Methods: Randomized controlled trials published between January 1st, 2003 and February 28th, 2014 comparing the preventive effects against CI-AKI of pre-procedural statins vs. control (lower statin dose, no statin, or placebo) in patients undergoing CA/PCI were included.
Results: Data were combined from 9 clinical trials enrolling 5212 patients (age 65 +/- 5 years, 63% males). Pooled analysis showed that intensive, short-term statin pre-treatment significantly reduced the risk of CI-AKI as compared to control (relative risk [RR] 0.50; 95% confidence interval [CI] 0.39 to 0.64; P < 0.001). Pre-specified subgroup analysis showed that intensive statin pre-treatment significantly reduced CI-AKI risk in patients with ACS (RR 0.37; 95% CI 0.25 to 0.55; P < 0.0001), with only a non-significant positive trend in patients without ACS (RR 0.65; 95% CI 0.41 to 1.03; P = 0.07). No evidence of publication bias was detected.
Conclusions: Short-term, pre-procedural, intensive statin treatment significantly reduced CI-AKI incidence in ACS patients, and may contribute to the overall clinical benefit associated with the early use of these drugs in this clinical setting. Its role in non-ACS patients warrants further investigation.

• 出版日期2015-3-15