Statin pretreatment reduces contrast nephropathy in PCI

Patients treated with a statin starting before percutaneous coronary intervention had a dramatic reduction in their rate of contrast-induced nephropathy, compared with patients who weren’t pretreated, in a study with more than 400 patients.

Statin pretreatment might work by reducing inflammation and oxidative stress. In addition, lower incidence of contrast-induced nephropathy during and immediately after percutaneous coronary intervention (PCI) might lead to improved long-term outcomes.

The Atorvastatin for Reduction of Myocardial Damage During Angioplasty (ARMYDA)-RENAL study enrolled consecutive patients who underwent PCI for either acute coronary syndrome or stable angina at the Campus Bio-Medico University in Rome. Patients scheduled for elective PCI were randomized to receive either 40mg atorvastatin daily or placebo starting 7 days before their procedure. Patients who underwent PCI for acute coronary syndrome received either an 80mg dose of atorvastatin 12 hours before the procedure and a second 40mg dose immediately before the procedure, or placebo. All patients received 40mg atorvastatin daily after the procedure.

The study did not receive commercial support. The impact of atorvastatin pretreatment on the incidence of death, myocardial infarction, or need for revascularization in patients with acute coronary syndrome was the focus of a second report at the meeting from the same researchers.   

The primary end point of the ARMY-DA-RENAL study was post-procedural incidence of contrast-induced nephropathy, defined as an increase in serum creatinine of at least 25% over the baseline level, or by at least 0.5 mg/dL.

Among the 260 patients who received statin pretreatment, the incidence of contrast-induced nephropathy was 3% vs. 27% in patients who weren’t pretreated, a statistically significant difference. Prior to PCI, the average creatinine clearance rate was about 83 mL/min in those with no pretreatment, also a statistically significant difference, reported by a cardiologist at the University, and his associates.

In a multivariable analysis that controlled for several differences between the two study groups at baseline, patients who received atorvastatin pretreatment had a 90% drop in their rate of contrast-induced nephropathy, compared with patients who did not get pretreatment. The only patient characteristic that blunted the benefit from statin pretreatment was a baseline creatinine clearance rate of less than 40mL/min.

Pretreated patients also had significantly better outcomes with follow-up out to 4 years. For example, the rate of major adverse cardiac events after 4 years was 6% in statin-pretreated patients and 36% in those with no pretreatment.