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Evaluating the Benefits of High-Dose Statin Loading in STEMI Management: Insights from a Meta-Analysis of Randomized Controlled Trials
Session:
SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker:
Bernardo Lisboa Resende
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.2 Acute Cardiac Care – Prehospital and Emergency Department Care
Session Type:
Cartazes
FP Number:
---
Authors:
Bernardo Manuel Lisboa Resende; Tomás Carlos; Luísa Gomes Rocha; Mafalda Griné; Miguel Vicente; Ana Luísa Silva; Mariana Simões; Gonçalo Batista; Tatiana Santos; Rafaela Fernandes; João Gameiro; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Background: </strong><span style="background-color:white"><span style="color:black">Acute ST-Elevation Myocardial Infarction (STEMI) is a medical emergency that requires prompt reperfusion therapy. Although percutaneous coronary intervention (PCI) is recognized as the standard treatment, the periprocedural pharmacological management of STEMI remains a topic of debate, with potential for improvement. Several observational studies and randomized clinical trials (RCTs) on patients with STEMI suggest that prior high-dose statin loading may enhance coronary blood flow, evidenced by the Thrombolysis In Myocardial Infarction (TIMI) frame count after PCI, and is also associated with improved short-term clinical outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Purpose: </strong>Conduct a Systematic Review and Meta-Analysis to evaluate the efficacy of high-dose statin loading in STEMI patients undergoing PCI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:#231f20">Methods:</span></strong> <span style="color:black">We systematically searched the Cochrane Controlled Register of Trials, EMBASE, and PubMed for RCTs. The primary outcome was post-PCI TIMI flow 3, while the secondary endpoint was a composite of 30-day Major Adverse Cardiovascular Events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke within 30 days. Loading strategies of 40-80 mg of atorvastatin or 20-40 mg of rosuvastatin were admitted. We pooled dichotomous data using odds ratios (OR) to describe effect sizes, employing a Mantel-Haenszel procedure in a random-effects model, with a 95% confidence interval. Heterogeneity was assessed statistically using the I² index (<25% low, 25%-50% moderate, >50% high heterogeneity).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">Of the 1,085 records identified, six studies were included, providing data on a total of 1,599 patients. Our meta-analysis revealed a higher incidence of post-PCI TIMI flow 3 in the high-dose statin group (pooled OR 2.08 [1.28, 3.38], P=0.63, I²=0). Additionally, the experimental strategy demonstrated a lower rate of 30-day MACE (pooled OR 0.55 [0.37, 0.82], P=0.55; I²=0%). Although we included only RCTs, we acknowledge that the outcomes analyzed in our meta-analysis may encompass endpoints that were not utilized for calculating the sample size.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusions: </strong><span style="color:black">Our results indicate that high-dose statin loading prior to PCI in STEMI patients is associated with a significant improvement in post-PCI TIMI flow 3 and a reduction in the incidence of 30-day MACE. These findings support the clinical benefit of implementing high-dose statin loading in the acute management of STEMI. Therefore, we consider that further research is warranted with larger-scale RCTs. </span></span></span></p>
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