Short-term clinical effects of periprocedural statin therapy

In high-risk patients, long-term statin therapy prevents cardiovascular events. Short-term clinical benefit of statin therapy has been recently evaluated by randomized clinical trials in the setting of vascular surgery, coronary bypass surgery and percutaneous coronary interventions. According to the trial scheme, statin therapy was started either few weeks or few hours before the intervention. In the field of vascular surgery, the clinical benefit of pre-procedure statin administration has been supported by DECREASE III trial. Fluvastatin significantly decreased the incidence of periprocedural myocardial ischemia as defined by ECG changes or troponin elevation. However, this study has methodological flaws, including primary endpoint modification during the trial and the lack of clinical relevance of this endpoint. The administration of statins before a coronary bypass could reduce the occurrence of postoperative atrial fibrillation, according to 4 randomized trials. This finding is discordant with the result of a recent meta-analysis of long-term published and unpublished long-term trials that showed no significant beneficial effects of statins on atrial fibrillation. Several trials have evaluated the usefulness of statin pretreatment before PCI. Most of them have found that statin pretreatment prevents periprocedural myocardial infarctions or major cardiac events. However, most of these events were isolated enzymatic elevations. Moreover, myocardial infarction definition was at odds with the recommendations in some of these trials. A recent meta-analysis of these trials has found that statin pretreatment leads to a 44% reduction in the incidence of major cardiac events at 30 days. The magnitude of this decrease is not consistent with the results of previous long-term trials evaluating statins after acute coronary syndromes. Current evidence does not strongly support short-term clinical benefit of pre-procedural statin administration.