| Objective: We aimed to evaluate the potential effect of high-dose statin pretreatment on post-procedure myocardial perfusion and MACE rate in patients receiving PCI.To explore the protective mechanism of statins on coronary reperfusion.Methods: We searched randomized controlled trials until January 2018,which evaluate the effect of high-dose statin pretreatment on post-PCI no-reflow phenomenon or final TIMI flow grade and MACE in patients undergoing PCI from the databases of Pubmed,Embase and Cochrane Library.We extracted the basic information and assessed the bias risk of enrolled trials according to Cochrane Collaboration's Tool after screening.All the data were pooled for analysis by Rev Man 5.1 software,and were stratified by type of statin,clinical presentation and statin current therapy status in subgroup.The quality assessment of every result was using GRADE profiler.In addition,the sensitivity analysis was using the Stata12.0 software.Egger's regression test for publication bias.Results: 1.15 randomized controlled clinical trials published from 2009 to 2016 were selected with 4240 individuals that 2120 patients in high-dose statin group and 2120 patiens in control group.2.All included trails used high-dose statin pretreatment as the intervention therapy and mentioned the result of post-PCI TIMI flow grade or no-reflow phenomenon.There were 90 patients with TIMI flow grade<3 in high-dose statin group and 143 patients in control group which weighted at 4.2% and 6.7%.The pooled analysis showed that high-dose statin pretreatment before PCI significantly improved the final TIMI flow grade and reduced no-reflow phenomenon compared with the control group(OR= 0.61,95% CI:0.46 to 0.80,P=0.0005)3.Among all the trials,there were 7 clinical trials with 1986 patients mentioned the result of MACE after PCI from 1 month to 1 year.There were 79 patients in high-dose statin group and 140 patients in control group which weighted at 7.9% and 14.1%.The pooled analysis showed that high-dose statin took a favorable trend to reduce the incidence of MACE(OR =0.53,95%CI: 0.39 to 0.71,P<0.0001).4.Subgroup analysis was performed according to the type of statins.In atorvastatin subgroup with 7 trails,the pooled analysis showed that high-dose atorvastatin significantly improved the final TIMI flow grade compared with the control group and reduced the no-reflow phenomenon(OR 0.6,95%CI:0.39 to 0.94,P=0.03,I2=35%).In rosuvastatin subgroup with 6 trails,analysis showed that high-dose rosuvastatin had no significant effect on the final TIMI flow grade compared with the control group(OR 0.64,95%CI: 0.43 to 1.04,P=0.07,I2=0%).5.Subgroup analysis was performed according to the different clinical presentation.In ACS subgroup with 9 trails,the pooled analysis showed that high-dose statin significantly improved final TIMI flow grade and reduced the no-reflow phenomenon compared with the control group(OR 0.60,95%CI: 0.43 to 0.84,P=0.003,I2=1%).In SAP subgroup with 5 trails,analysis showed that high-dose statin had no significant effect on the final TIMI flow grade compared with the control group(OR 0.67,95%CI: 0.38 to 1.17,P=0.16,I2=0%).6.Subgroup analysis was performed according to the statin current therapy status.There were 11 trails in statin-naive subgroup and 3 trails in previous statin subgroup.The pooled analysis showed that in statin-naive subgroup,high-dose statin significantly improved final TIMI flow grade compared with the control group(OR 0.58,95%CI:0.40 to 0.83,P=0.003,I2=0%).But in previous statin subgroup,analysis showed that high-dose statin had no significant effect on the final TIMI flow grade compared with the control group(OR= 0.85,95%CI: 0.45 to 1.62,P=0.62,I2=0%).Conclusion: 1.High-dose statin pretreatment has great protective effect on post-procedure myocardial perfusion by improving the TIMI flow and reduced the no-reflow phenomenon in patients undergoing PCI,especially in ACS patients,with atorvastatin pretreatment as well as in statin-naive patients.2.High-dose statin preloading significantly reduces the incidence of MACE. |
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