Efficacy of High-Dose Statins in Preventing Contrast-Induced Nephropathy Post-cardiac Catheterization

Abstract

Contrast-induced nephropathy (CIN) is defined as an increase in serum creatinine (s-CR) of at least 0.5 mg/dL or a 25% or greater increase from baseline within 48-72 hours of contrast agent administration. High-dose statins have been proposed as a prophylactic measure against CIN. This updated systematic review and meta-analysis aimed to assess the efficacy of peri-procedurally administered high-dose statins in preventing CIN in patients who underwent cardiac catheterization. A comprehensive literature review of PubMed and Embase was conducted with a distinct focus on studies published in the last 15 years up to June 2024. The study included randomized controlled trials (RCTs) that assessed the impact of high-dose statin treatment during or around the time of cardiac catheterization on the rate of contrast-induced nephropathy (CIN). It excluded trials comparing low-dose statins or statins used in non-cardiac surgeries, as well as studies with missing data or unclear end points on CIN. The primary objective was to evaluate the efficacy of high-dose statins administered peri-angiography to prevent CIN. Random effects were used using the DerSimonian and Laird method. A subgroup analysis was performed to assess the effectiveness of high-dose statins in preventing CIN in patients on chronic statin therapy. Our pooled analysis of 2,312 participants revealed a significantly lower incidence of CIN (odds ratio (OR): 0.47, 95% confidence interval (CI): 0.30-0.72, P = 0.0007, I²: 38%) in the high-dose statin group compared to the control group. However, the subgroup analysis showed no benefit of high-dose statins in decreasing the incidence of CIN in individuals already on chronic statin therapy (OR: 1.03, 95% CI: 0.33-3.18, P = 0.97). Our study highlights the beneficial effect of high-dose statins in preventing CIN in statin-naive patients. However, no benefit was observed in patients who were on chronic statin therapy.

Keywords: chronic statin therapy; contrast-induced nephropathy; high-dose statins; outcome; percutaneous coronary intervention.

Figure 1. PRISMA Flow Diagram Illustrating the Identification, Screening, Selection, and Inclusion of Studies for Final Analysis

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest Plot of Contrast-Induced Nephropathy Incidence in High-Dose Statins Versus Control

Figure 3. Forest Plot of Subgroup Analysis of the Effect of High-Dose Statins on Contrast-Induced Nephropathy Incidence in Patients Already on Chronic Statin Therapy

Figure 4. Cochrane RoB Tool Assessment for the Included RCTs

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