Efficacy of Short-Term High-Dose Statin Pretreatment in Prevention of Contrast-Induced Acute Kidney Injury: Updated Study-Level Meta-Analysis of 13 Randomized Controlled Trials

Abstract

BackgroundThere have been conflicting results across the trials that evaluated prophylactic efficacy of short-term high-dose statin pre-treatment for prevention of contrast-induced acute kidney injury (CIAKI) in patients undergoing coronary angiography (CAG). The aim of the study was to perform an up-to-date meta-analysis regarding the efficacy of high-dose statin pre-treatment in preventing CIAKI.Methods and ResultsRandomized-controlled trials comparing high-dose statin versus low-dose statin or placebo pre-treatment for prevention of CIAKI in patients undergoing CAG were included. The primary endpoint was the incidence of CIAKI within 2–5days after CAG. The relative risk (RR) with 95% CI was the effect measure. This analysis included 13 RCTs with 5,825 total patients; about half of them (n = 2,889) were pre-treated with high-dose statin (at least 40 mg of atorvastatin) before CAG, and the remainders (n = 2,936) pretreated with low-dose statin or placebo. In random-effects model, high-dose statin pre-treatment significantly reduced the incidence of CIAKI (RR 0.45, 95% CI 0.35–0.57, p<0.001, I2 = 8.2%, NNT 16), compared with low-dose statin or placebo. The benefit of high-dose statin was consistent in both comparisons with low-dose statin (RR 0.47, 95% CI 0.34–0.65, p<0.001, I2 = 28.4%, NNT 19) or placebo (RR 0.34, 95% CI 0.21–0.58, p<0.001, I2 = 0.0%, NNT 16). In addition, high-dose statin showed significant reduction of CIAKI across various subgroups of chronic kidney disease, acute coronary syndrome, and old age (≥60years), regardless of osmolality of contrast or administration of N-acetylcystein.ConclusionsHigh-dose statin pre-treatment significantly reduced overall incidence of CIAKI in patients undergoing CAG, and emerges as an effective prophylactic measure to prevent CIAKI.

Short‐Term High‐Dose Vitamin E to Prevent Contrast Medium–Induced Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo‐Controlled Trial

“…The authors concluded that further trials were required to better define the role of statins for protection against CIAKI in the setting of coronary angiography, particularly in patients with CKD stage ≥3 . Moreover, in another meta‐analysis, Lee et al found that short‐term high‐dose statin (≥40 mg atorvastatin) significantly reduced the incidence of CIAKI compared with low‐dose statin or placebo in patients undergoing coronary angiography . In our study, we were unable to show the benefits of statin use beyond the study intervention.…”

“…36 Moreover, in another meta-analysis, Lee et al found that short-term highdose statin (≥40 mg atorvastatin) significantly reduced the incidence of CIAKI compared with low-dose statin or placebo in patients undergoing coronary angiography. 37 In our study, we were unable to show the benefits of statin use beyond the study intervention. We think that the main limitation of this study in this regard was the small sample size to detect statin effects.…”

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

“…Several studies have shown the efficacy of short-term, high-dose statins in reducing the incidence of CIN in patients undergoing cardiac catheterization. 11,12 Thus, the implementation of high-dose statin before coronary angiography should be considered as an additional preventive measure in patients without contraindications.…”

Preventive effect of nicorandil on contrast‐induced nephropathy: a meta‐analysis of randomised controlled trials

“…1,[6][7][8]13,14 However, the results were controversial and inconsistent. We found that nicorandil was associated with significantly reduced incidence of CIN, SCr and cystatin C level.…”