RETRACTED: Short-term and long-term effects of a loading dose of atorvastatin before percutaneous coronary intervention on major adverse cardiovascular events in patients with acute coronary syndrome: a meta-analysis of 13 randomized controlled trials.

Abstract

Whether a loading dose of atorvastatin (80 mg) can reduce major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) remains controversial. Therefore, we performed this meta-analysis. Randomized controlled trials (RCT) comparing a loading dose of atorvastatin to a control in patients with ACS who underwent PCI were identified through searches of medical literature databases. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the primary endpoint. Finally, 13 trials enrolling 22 095 patients were included; of the 22 095 patients, 11 214 (50.7%) received loading doses of 80 mg of atorvastatin. Compared with the control, atorvastatin significantly reduced MACE (RR: 0.66, 95% CI 0.54-0.80), myocardial infarction (MI; RR: 0.61, 95% CI 0.46-0.80), revascularization (RR: 0.76, 95% CI 0.69-0.83), and stroke (RR: 0.69, 95% CI 0.49-0.96). There was no difference in death or rehospitalization between the two groups. In the subgroup analysis, atorvastatin still significantly reduced MACE (RR: 0.57, 95% CI 0.39-0.85) and MI (RR: 0.61, 95% CI 0.42-0.89) within 30 days. Furthermore, atorvastatin still remarkably reduced MACE (RR: 0.70, 95% CI 0.55-0.89), MI (RR: 0.58, 95% CI 0.36-0.95), and revascularization (RR: 0.76, 95% CI 0.69-0.84) after more than 30 days. No significant differences were observed in death or stroke within 30 days or after more than 30 days. Our meta-analysis supports the concept that a loading dose of atorvastatin markedly reduces cardiovascular events in patients with ACS.