Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention.

@article{citeulike:2675329, abstract = {Contrast-induced nephropathy (CIN) is an important cause of mortality and morbidity in patients undergoing angiography. This study investigated whether statins decrease incidence of CIN in the setting of percutaneous coronary intervention (PCI) and evaluated the influence of such potential benefit on long-term outcome. Four-hundred thirty-four patients undergoing PCI were prospectively enrolled and followed up to 4 years. Patients were stratified according to preprocedural statin therapy (260 statin treated, 174 statin naive). CIN was defined as a postprocedural increase in serum creatinine of >or=0.5 mg/dl or>25\% from baseline. Follow-up assessment included 4-year occurrence of major adverse cardiac events. Statin-treated patients had a significantly lower incidence of CIN (3\% vs 27\%, p<0.0001; 90\% risk decrease) and had better postprocedural creatinine clearance (80+/-20 vs 65+/-16 ml/min, p<0.0001). Benefit of statin before treatment was observed in all subgroups, except in patients with a pre-existing creatinine clearance<40 ml/min. During follow-up, CIN was a predictor of poorer outcome; 4-year survival free of major adverse cardiac events was highest in statin-treated patients without CIN (95\%, p<or=0.015) and lowest in statin-naive patients with CIN (53\%, p<or=0.018). In conclusion, patients receiving statins before PCI have a significant decrease of CIN; this early protective effect translates into better long-term event-free survival. These results may lend further support to utilization of statins as adjuvant pharmacologic therapy before PCI.}, address = {Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy.}, author = {Patti, G. and Nusca, A. and Chello, M. and Pasceri, V. and D'Ambrosio, A. and Vetrovec, G. W. and Di Sciascio, G. }, citeulike-article-id = {2675329}, comment = {This is a prospective, observational study of the impact of statins on the rate of iodinated contrast-induced acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention. Despite the baseline preserved rate of renal filtration function (84 ml/min), there was a dramatic AKI rate reduction with statins, 3 versus 27\%. This is another paper in the growing body of evidence supporting the concept that statins reduce rates of AKI not only after iodinated contrast, but after coronary artery bypass surgery as well. Thus, all patients with coronary disease have an indication for the use of a statin for atherosclerosis; they also appear also to benefit from a reduction in the risk of AKI. Future randomized trials of statin use in these acute applications are warranted.--Peter A. McCullough, MD, MPH }, doi = {10.1016/j.amjcard.2007.08.030}, issn = {0002-9149}, journal = {The American journal of cardiology}, keywords = {cardiovascular, hplp, nephropathy, prevention}, month = {February}, number = {3}, pages = {279--285}, posted-at = {2008-04-15 21:34:40}, priority = {2}, title = {Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention.}, url = {http://dx.doi.org/10.1016/j.amjcard.2007.08.030}, volume = {101}, year = {2008} }

TY - JOUR ID - citeulike:2675329 L3 - citeulike-article-id:2675329 TI - Usefulness of statin pretreatment to prevent contrast-induced nephropathy and to improve long-term outcome in patients undergoing percutaneous coronary intervention. JF - The American journal of cardiology VL - 101 IS - 3 SP - 279 EP - 285 AD - Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy. SN - 0002-9149 N2 - Contrast-induced nephropathy (CIN) is an important cause of mortality and morbidity in patients undergoing angiography. This study investigated whether statins decrease incidence of CIN in the setting of percutaneous coronary intervention (PCI) and evaluated the influence of such potential benefit on long-term outcome. Four-hundred thirty-four patients undergoing PCI were prospectively enrolled and followed up to 4 years. Patients were stratified according to preprocedural statin therapy (260 statin treated, 174 statin naive). CIN was defined as a postprocedural increase in serum creatinine of >or=0.5 mg/dl or>25% from baseline. Follow-up assessment included 4-year occurrence of major adverse cardiac events. Statin-treated patients had a significantly lower incidence of CIN (3% vs 27%, p<0.0001; 90% risk decrease) and had better postprocedural creatinine clearance (80+/-20 vs 65+/-16 ml/min, p<0.0001). Benefit of statin before treatment was observed in all subgroups, except in patients with a pre-existing creatinine clearance<40 ml/min. During follow-up, CIN was a predictor of poorer outcome; 4-year survival free of major adverse cardiac events was highest in statin-treated patients without CIN (95%, p<or=0.015) and lowest in statin-naive patients with CIN (53%, p<or=0.018). In conclusion, patients receiving statins before PCI have a significant decrease of CIN; this early protective effect translates into better long-term event-free survival. These results may lend further support to utilization of statins as adjuvant pharmacologic therapy before PCI. KW - cardiovascular KW - hplp KW - nephropathy KW - prevention N1 - This is a prospective, observational study of the impact of statins on the rate of iodinated contrast-induced acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention. Despite the baseline preserved rate of renal filtration function (84 ml/min), there was a dramatic AKI rate reduction with statins, 3 versus 27%. This is another paper in the growing body of evidence supporting the concept that statins reduce rates of AKI not only after iodinated contrast, but after coronary artery bypass surgery as well. Thus, all patients with coronary disease have an indication for the use of a statin for atherosclerosis; they also appear also to benefit from a reduction in the risk of AKI. Future randomized trials of statin use in these acute applications are warranted.--Peter A. McCullough, MD, MPH AU - Patti, G AU - Nusca, A AU - Chello, M AU - Pasceri, V AU - D'Ambrosio, A AU - Vetrovec, GW AU - Di Sciascio, G PY - 2008/02/01/ UR - http://dx.doi.org/10.1016/j.amjcard.2007.08.030 ER -