Dmitriy N. Feldman, MD
Associate Professor of Medicine, Director of Endovascular Services, Weill Cornell Medical College, New York Presbyterian Hospital, Greenberg Division of Cardiology, 520 East 70th Street, Starr-434 Pavilion, New York, NY 10021. Email: firstname.lastname@example.org
Recent evidence from trials suggests that preprocedural high-dose statin therapy prior to contrast exposure may reduce the incidence of contrast-induced nephropathy (CIN). The pleiotropic effects of statins, which include anti-inflammatory, antioxidant, and antithrombotic properties, are thought to be renally protective. While prior investigations on this topic have largely focused on higher-risk ACS patients, our study aimed to examine the effect of chronic statin therapy on the incidence of postprocedural CIN in a cohort of patients undergoing non-emergent PCI in the current interventional era. In our retrospective analysis of patients undergoing non-emergent PCI, chronic statin therapy significantly reduced the odds of developing CIN after adjusting for patient-related and procedure-related factors. Overall, 4.5% developed CIN following PCI and the incidence of CIN following PCI was not significantly different between patients on chronic statin therapy versus those not on chronic statin therapy (4.2% vs 5.4%; P=.42). However, after multivariate adjustment, chronic statin therapy was associated with a lower incidence of CIN (odds ratio 0.21; 95% CI, 0.05-0.94; P=.04).
Our study in this month’s Journal of Invasive Cardiology adds to the body of data supporting importance and benefit of chronic statin therapy for the prevention of CIN, with extension to the non-emergent PCI setting. Given the potential benefits and minimal risks associated with periprocedural loading with statins, preprocedural loading with a high-dose statin should be strongly considered even in elective PCI, whether or not patients are receiving chronic statin therapy. Further studies are needed to demonstrate whether high-dose statin loading immediately before angiography in patients without clear indications for statins should be performed for the purpose of renal protection alone and whether periprocedural high-dose statin loading should be administered to patients already on chronic statin therapy.
A selection of JIC article highlighting Contrast-Induced Nephropathy:
- Comparison of Iodixanol and Ioxaglate for Coronary Optical Coherence Tomography Imaging, by Christakopoulos et al.
- TEE-Guided Transcatheter Aortic Valve Implantation With “Zero Contrast” — A Viable Alternative for Patients with Chronic Kidney Disease, by Pershad et al.
- Automated Carbon Dioxide Digital Angiography for Lower-Limb Arterial Disease Evaluation: Safety Assessment and Comparison With Standard Iodinated Contrast Media Angiography, by Scalise et al.