Intérêt des statines dans la prévention des infarctus postangioplastie coronaire : revue systématique et méta-analyse

Postprocedural myocardial necrosis as indicated by biomarkers increase is frequent after percutaneous coronary interventions (PCI) in up to 40% of cases. Pretreatment by statin could reduce the occurrence of those periprocedural myonecrosis. Medline and Cochrane Database screenings allow us to select articles published until March 2007. Sixteen prospective and retrospective studies have been identified in relation with the impact of statin pretreatment on periprocedural myonecrosis or morbimortality outcomes in patients who underwent PCI. Among selected studies, 12 provide the rate of periprocedural myocardial infarction. The relative risk (RR) of periprocedural myocardial necrosis in patients pretreated with statin was 0.50 (95% CI: 0.40-0.63). Among the 5409 patients with clinical follow-up ensured until six months, the RR of death in patients pretreated with statin before the PCI was 0.64 (95% CI: 0.44-0.93). Significant heterogeneity was observed in the results. In sensitivity analysis, stable and unstable patients were compared with similar RR reduction of periprocedural myonecrosis in favour of patients receiving statin before PCI. In the present meta-analysis, we confirm that statin pretreatment before PCI is able to reduce periprocedural myonecrosis and suggest a potential impact on six months survival of patients.