Abstract
I read with interest a study by Kenaan et al concluding that, among 80,493 consecutive, nonemergency percutaneous coronary intervention's (PCI) patients from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry, one-third of patients did not receive statins before PCI, which had no consequences in terms of major inhospital adverse events or long-term mortality. I wish to support their experience and comment on our randomized studies dealing with this topic.
There are several observational and randomized studies demonstrating that both statin-naive patients and patients on chronic statin therapy assigned to pretreatment with statins were associated with a reduced occurrence of myocardial injury or periprocedural myocardial infarction. These findings led to recommendation to use loading or reloading with high-dose statins before PCI.
Our first nonrandomized observation suggested that pretreatment with different types of statins in patients undergoing PCI for stable angina led to reduced risk and extent of procedure-related myocardial injury. These encouraging data were consistent with several similar studies published at that time.
Therefore, we performed series of randomized TIP trials to demonstrate efficacy of atorvastatin/rosuvastatin therapy before PCI.and Unfortunately, none of these studies was able to confirm any protective effect of statins. Only the international, multicenter TIP 3 trial suggested that, in patients with an advanced inflammatory status, rosuvastatin therapy might have a cardioprotective effect.6 Thus, although the study by Kenaan et al1 does not accord with most previous studies, it is consistent with the TIP 1 to 3 trials demonstrating the absence of both short- and long-term effects of atorvastatin/rosuvastatin therapy before PCI in low-risk patients.
Of course, anyone with coronary artery disease should be treated with statins, but I am not sure that it must happen just before PCI.