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

Abstract

Background and ObjectivesContrast-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 MethodsA 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.ResultsThe 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).ConclusionHigh-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.

Association between Serum Ferritin and Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…The incidence of CIN in this study reached up to 17.5% despite performing hydration as a preventive measure in most of the patients. This is consistent with previous reports [ 3 , 15 , 16 ]. The high risk of CIN in patients with ACS should be seriously considered in clinical practice because the onset of CIN would lead to not only extended hospital stays but also irreversible renal functional decline [ 5 ].…”

Rosuvastatin Treatment for Preventing Contrast-Induced Acute Kidney Injury After Cardiac Catheterization

“… 23 Patients with CKD had a significant higher mean C reactive protein concentration, 24 which contributed to the development of CI-AKI, 25 therefore rosuvastatin may be effective in such patients. However, when the study by Leoncini et al was excluded from our analysis, rosuvastatin was not effective at preventing CI-AKI in CKD patients undergoing elective cardiac catheterization, in accordance with studies by Han et al, 5 Abaci et al, 7 and Yun et al 26 The 2014 European Society of Cardiology's revascularization guidelines 27 recommended as a Class IIa indication that patients with moderate to severe CKD be treated with statins (rosuvastatin or atorvastatin) before CM exposure for protection against CI-AKI. Leoncini et al 6 and the meta-analysis by Liu et al 3 were cited for this recommendation.…”

Guideline on the Use of Iodinated Contrast Media in Patients With Kidney Disease 2018

“…Eight studies have compared statins with placebo, among which 7 were published after 2011. [277][278][279][280][281][282][283][284] The target population was patients undergoing cardiovascular interventions, and many studies included patients with normal renal function (eGFR >60 mL/min/1.73 m 2 ). Only 2 studies compared statins with placebo in patients with impaired renal function.…”