Critical Pathways in Cardiology

Preprocedural Statin Therapy to Prevent Myocardial Damage in Percutaneous Coronary Intervention: A Review of Randomized Trials

When should you start statins in acute coronary syndrome (ACS) patients?  A key question - that is addressed by a new state-of the art review on the use of statins prior to percutaneous coronary intervention (PCI) by Mega and colleagues. While numerous landmark clinical trials have demonstrated the beneficial effects of statin therapy for both primary and secondary prevention, the question of of how early to treat relative to acute ACS presentation is less clear. A key issue has been whether treatment prior to PCI would help reduce peri-procedural events, and if so, then starting statins on admission would be an optimal approach.  In this article, Mega and colleagues (including myself) review the several randomized trials on this topic.  Although they are each only modest sized trials, a clear and consistent pattern is seen: They show that pretreatment with statin before elective PCI reduces periprocedural myocardial injury in patients with with ACS or stable angina. Thus, this new evidence strongly supports routine utilization of high-dose statins as adjuvant pharmacological therapy before PCI. 

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Society of Chest Pain Centers