Early High-Dose Rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome: Results From the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On Contrast-Induced Acute Kidney Injury and Myocardial Damage in Patients With Acute Coronary Syndrome)

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• 作者：Mario Leoncini ; Anna Toso ; Mauro Maioli ; Francesco Tropeano ; Simona Villani ; Francesco Bell ; i
• 关键词：acute coronary syndrome(s) ; contrast-induced nephropathy ; statins
• 刊名：Journal of the American College of Cardiology
• 出版年：7-14 January, 2014
• 年：2014
• 卷：63
• 期：1
• 页码：71-79
• 全文大小：435 K

文摘

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Objectives

This study sought to determine if in addition to standard preventive measures on-admission, high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI).

Background

Patients with acute coronary syndrome (ACS) are at high risk for CI-AKI, and the role of statin pre-treatment in preventing renal damage remains uncertain.

Methods

Consecutive statin-na茂ve non-ST elevation ACS patients scheduled to undergo early invasive strategy were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; statin group n聽= 252) or no statin treatment (control group n聽= 252). CI-AKI was defined as an increase in creatinine concentration of聽鈮?.5 mg/dl or聽鈮?5% above baseline within 72 h after contrast administration.

Results

The incidence of CI-AKI was significantly lower in the statin group than in controls (6.7% vs. 15.1%; adjusted odds ratio: 0.38; 95% confidence interval [CI]: 0.20 to 0.71; p聽= 0.003). The benefits against CI-AKI were consistent, even applying different CI-AKI definition criteria and in all the pre-specified risk categories. The 30-day incidence of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) was significantly lower in the statin group (3.6% vs. 7.9%, respectively; p聽= 0.036). Moreover, statin treatment given on admission was associated with a lower rate of death or nonfatal myocardial infarction at 6 month follow-up (3.6%聽vs. 7.2%, respectively; p聽= 0.07).

Conclusions

High-dose rosuvastatin given on admission to statin-na茂ve patients with ACS who are scheduled for an early invasive procedure can prevent CI-AKI and improve short-term clinical outcome. (Statin Contrast Induced Nephropathy Prevention [PRATO-ACS]; )