GW29-e1034 Can eastern Asian population with acute coronary syndrome derive short-term cardiac benefit from high dose statin loading prior to percutaneous coronary intervention ?: systematic review and meta-analysis

[...]most relevant studies obtained a preponderance of western population, therefore the presumptive magnitude of cardiac benefit merits scrutiny in Asian population.Our aim is to synthesise data from major randomized controlled trials to gain insight into this controversy.Methods Literature in Medline and Embase database from inception to 31 March 2018 were scrutinized for relevant studies using Internet-based search engines. 1919 patients were identified from 9 randomized studies for the present meta-analysis.The primary endpoint was the 30-day incidence of major adverse cardiac events (MACEs) inclusive of death,myocardial infarction (MI), stroke, target vessel revascularization (TVR).Results High dose statin loading was associated with a significant lower 30-day rate of MACEs compared with conventional care (6.96% vs. 12.3%; odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.30 to 0.74; p = 0.001), driven by reduction in the occurrence of MI (5% vs. 8.73%; OR: 0.50; 95% CI: 0.34 to 0.73; p = 0.0004) whereas no significant differences in death (0.2% vs. 0.9%; OR: 0.37; 95% CI: 0.09 to 1.44; p = 0.15), stroke (0.5% vs. 0.8%; OR: 0.63; 95% CI: 0.20 to 1.98; p =0.43) or TVR (0.7% vs. 1.6%; OR: 0.54; 95% CI: 0.23 to 1.27; p =0.16). To assess whether specific category of statin was more likely related to the optimal results, a subgroup analysis was performed for studies where rosuvastatin or atorvastatin was prescribed in high dose statin loading, and a prominent benefit was observed in the rosuvastatin subgroup (OR: 0.37; 95% CI: 0.24 to 0.58; p = 0.0001) with absence of heterogeneity (I2 = 0%; p = 0.74), whereas pretreatment with high dose of atorvastatin did not significantly attenuate MACEs rate within 30 days post PCI. Based on the visual inspection of the funnel plot and Egger's test for MACEs, the presence of a small publication bias was suggested.Conclusions From the available RCT data pertaining to high dose statin loading prior to PCI in eastern Asian patients with ACS, a consistent tendency was revealed in favor of MACEs and the component endpoints of death or MI occurrence 30 days post PCI as in some large clinical trials conducted in western population.