Efficacy of High-dose Statin for Prevention of Contrast- Induced Nephropathy (CIN) in Patients Undergoing Coronary Angiography: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury. Previous trials on statins for CIN prevention are conflicting and meta-analyses of these are inconclusive. We systematically reviewed randomized controlled trials (RCTs) comparing high-dose versus low-dose or no statin for CIN prevention in patients undergoing coronary angiography, incorporating several large trials performed since publication of prior meta-analyses.
Relevant studies were identified via searches of MEDLINE, Cochrane, Web of Science, CINAHL and EMBASE from inception to October 2013. RCTs on high-dose statins for CIN prevention in patients undergoing coronary angiography were included. Study-specific odds-ratios (OR) and 95% confidence interval (CI) were calculated and combined using random-effects model meta-analysis. Between-study heterogeneity was assessed using I2 statistics.
Twelve RCTs with 5564 patients were included. CIN was defined as 25% or 0.5 mg/dl or more serum Creatinine rise from baseline or at least 10% rise in Cystatin C within one week of contrast exposure. CIN occurred in 3.4% of 2769 patients pre-treated with high-dose statins and 7.6% of 2795 patients in the low-dose or no statin group [OR 0.43, 95% CI 0.33-0.55, I2 = 19%, p< 0.001]. Atributable risk reduction was 4.2%. Number needed to treat to prevent CIN was 24. Analysis of 1598 patients in Atorvastatin (lipophilic) studies showed CIN occurred in 4.3% of 788 high-dose and 11.7% of 810 of low-dose or placebo participants.[OR 0.35; 95% CI 0.23-0.52, I2 =31%, p< 0.001]. Analysis of Rosuvastatin (hydrophilic) studies with 3502 enrollees yielded similar results. CIN incidence in 1750 rosuvastatin patients was 2.5% versus 4.5% of 1752 placebo group patients [OR 0.54; 95% CI 0.37-0.79, I2 =0%, p< 0.001].
High-dose statin compared to low-dose or no statin pre-treatment for coronary angiography reduces the incidence of CIN. Both hydrophilic and lipophilic statins showed similar effects. Further trials should be geared towards identifying those who will derive maximum benefit from statins as well as effective statins and dosing strategies for preventing CIN.
American College of Cardiology Annual Meeting
Ukiagwe, A., Aryal, M., Karmacharya, P., Mahmood, M., Jalota, L., & Donato, A. A. (2014). Efficacy of High-dose Statin for Prevention of Contrast- Induced Nephropathy (CIN) in Patients Undergoing Coronary Angiography: A Systematic Review and Meta-analysis of Randomized Clinical Trials. American College of Cardiology Annual Meeting Retrieved from https://scholarcommons.towerhealth.org/gme_int_med_resident_program_read/499