Early high-dose rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome. Results from Protective effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with Acute Coronary Syndrome (PRATO-ACS Study).
J Am Coll Cardiol. 2013 Sep 25;
Authors: Leoncini M, Toso A, Maioli M, Tropeano F, Villani S, Bellandi F
Abstract
OBJECTIVES: The aim of the study was to determine if in addition to standard preventive measures on-admission high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI).
BACKGROUND: Patients with acute coronary syndrome (ACS) are at high risk for CI-AKI and the role of statin pre-treatment in preventing renal damage remains uncertain.
METHODS: Consecutive statin-naïve non-ST elevation ACS patients scheduled for early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on-admission following by 20 mg/day) (statin group, n=252) or no statin treatment (control group, n=252). CI-AKI was defined as an increase in creatinine ≥ 0.5 mg/dl or ≥ 25% above baseline within 72 hours after contrast administration.
RESULTS: The incidence of CI-AKI was significantly lower in the statin group than in controls [6.7 vs 15.1%; adjusted odds ratio, 0.38; 95% confidence interval, 0.20-0.71; p= 0.003]. The benefits against CI-AKI were consistent even applying different CI-AKI definition criteria and in all the pre-specified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke or persistent renal damage) was significantly lower in the statin group (3.6% vs 7.9 %; p = 0.036). Moreover, on-admission statin treatment was associated with a lower rate of death or non fatal myocardial infarction at the 6-month follow-up (3.6% vs 7.2%, p = 0.07).
CONCLUSIONS: On-admission high-dose rosuvastatin in statin-naïve patients with ACS scheduled for early invasive procedure can prevent CI-AKI and improve short-term clinical outcome.
PMID: 24076283 [PubMed - as supplied by publisher]