Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy

Abstract

Background and objectives: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS).

Subjects and methods: A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI.

Results: The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84±22.59% vs. 2.43±24.49%, p=0.038; -11.44±14.00 vs. -9.51±13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026).

Conclusion: High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.

Keywords: Contrast media; Kidney; Statins.

Fig. 1

Incidence of contrast-induced nephropathy. The incidence of the primary endpoint was significantly lower in the rosuvastatin group than that in the control group (13.5% vs. 18.8%, p=0.040). OR: odds ratio, CI: confidence interval.

Fig. 2

Incidence of an additional endpoint according to treatment group.

Fig. 3

Odds ratios (OR) for the occurrence of contrast-induced nephropathy in specific risk subgroups. CI: confidence interval, hsCRP: high-sensitivity C-reactive protein, MI: myocardial infarction, UAP: unstable angina pectoris, eGFR: estimated glomerular filtration rate.