Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.
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Berwanger Otavio, Santucci Eliana Vieira, de Barros E Silva Pedro Gabriel Melo, Jesuíno Isabella de Andrade, Damiani Lucas Petri, Barbosa Lilian Mazza, Santos Renato Hideo Nakagawa, Laranjeira Ligia Nasi, Egydio Flávia de Mattos, Borges de Oliveira Juliana Aparecida, Dall Orto Frederico Toledo Campo, Beraldo de Andrade Pedro, Bienert Igor Ribeiro de Castro, Bosso Carlos Eduardo, Mangione José Armando, Polanczyk Carisi Anne, Sousa Amanda Guerra de Moraes Rego, Kalil Renato Abdala Karam, Santos Luciano de Moura, Sposito Andrei Carvalho, Rech Rafael Luiz, Sousa Antônio Carlos Sobral, Baldissera Felipe, Nascimento Bruno Ramos, Giraldez Roberto Rocha Corrêa Veiga, Cavalcanti Alexandre Biasi, Pereira Sabrina Bernardez, Mattos Luiz Alberto, Armaganijan Luciana Vidal, Guimarães Hélio Penna, Sousa José Eduardo Moraes Rego, Alexander John Hunter, Granger Christopher Bull, Lopes Renato Delascio, SECURE-PCI Investigators
Аннотация
OBJECTIVE: To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017.
INTERVENTIONS: Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication.
MAIN OUTCOMES AND MEASURES: The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days.
RESULTS: Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group.
CONCLUSIONS AND RELEVANCE: Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use of loading doses of atorvastatin among unselected patients with ACS and intended invasive management.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01448642.