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Meta-Analysis
. 2013 Sep;36(9):E17-24.
doi: 10.1002/clc.22169. Epub 2013 Jul 24.

Effect of statin pretreatment on myocardial perfusion in patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis

Ting Lyu  1 , Yichao Zhao, Tuo Zhang, Wen Zhou, Fan Yang, Qing He, Ancai Yuan, Tianbao Yao, Jun Pu, Ben He
Affiliations
Meta-Analysis

Effect of statin pretreatment on myocardial perfusion in patients undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis

Ting Lyu et al. Clin Cardiol. 2013 Sep.

Abstract

Background: To achieve sufficient myocardial perfusion in ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI), many adjunctive therapies have been proposed. Previous trials have reported variances in myocardial perfusion improvement for statin pretreatment, which made it inconvincible to confirm the beneficial effects of statins. Therefore, we performed a systematic review and meta-analysis to determine whether statin pretreatment was effective in improving myocardial perfusion.

Hypothesis: Statin pretreatment could improve myocardial perfusion in STEMI patients undergoing PPCI.

Methods: We searched the PubMed, Web of Knowledge, and the Cochrane Library databases for studies evaluating the impact of statin pretreatment on myocardial perfusion in STEMI patients receiving PPCI.

Results: Twelve trials were finally included in our meta-analysis. There were no significant differences in patients' baseline characteristics between the statin pretreatment and control groups. Overall pooled analysis showed that patients in the statin pretreatment groups had significantly better epicardial coronary blood flow (measured by Thrombosis in Myocardial Infarction [TIMI] grade, odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.28 to 0.84; measured by corrected TIMI frame count, mean difference: -5.63; 95% CI: -9.66 to -1.6). A trend toward myocardial tissue level perfusion improvement was seen in the statin pretreatment arm rather than the control arm (measured by myocardial blush grade, OR: 0.74; 95% CI: 0.50 to 1.09).

Conclusions: This present meta-analysis suggests that statin pretreatment might be effective in improving myocardial perfusion in STEMI patients.

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Figures

Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Thrombosis in Myocardial Infarction (TIMI) grade comparison between statin pretreatment group and control group. (A) Overall effect of statins on TIMI grade for all of the studies included. (B) Overall effect of statins on TIMI grade for the retrospective studies included. (C) Overall effect of statins on TIMI grade for the randomized controlled trial studies included. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haensel.
Figure 3
Figure 3
Corrected TIMI frame count (cTFC) comparison between statin pretreatment group and control group. (A) Overall effect of statins on cTFC for all the studies included. (B) Overall effect of statins on cTFC for the retrospective studies included. (C) Overall effect of statins on cTFC for the randomized controlled trial studies included. Abbreviations: CI, confidence interval; SD, standard deviation; IV, inverse variance.
Figure 4
Figure 4
Myocardial blush grade (MBG) comparison between statin pretreatment group and control group. (A) Overall effect of statins on MBG for all the studies included. (B) Overall effect of statins on MBG for the retrospective studies included. (C) Overall effect of statins on MBG for the RCT studies included. Abbreviations: CI, confidence interval; M‐H, Mantel‐Haensel.
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References

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