SAN FRANCISCO — High-dose rosuvastatin appears to reduce risk for contrast-induced nephropathy in patients with non-ST elevation ACS, according to data from the PRATO-ACS trial presented at the American College of Cardiology Scientific Sessions.
From 2010 to 2012, Anna Toso, MD, of Misericordia e Dolce Hospital in Prato, Italy, and colleagues studied 504 statin-naïve patients with non-ST elevation ACS scheduled for early invasive strategy. Patients were randomly assigned placebo (n=252) or rosuvastatin 40 mg (Crestor, AstraZeneca) on admission to the coronary care unit, followed by 20 mg daily until discharge (n=252). All patients were injected with iodixanol for imaging and received antiplatelet therapy. Standard preventive measures, including hydration and N-acetylcysteine, were also used. After discharge, the rosuvastatin group received 20 mg or 10 mg daily, depending on kidney function as measured by creatinine clearance, and the control group received atorvastatin 40 mg daily. Development of contrast-induced acute kidney injury (≥25% above baseline within 24 hours) served as the primary endpoint.
Results revealed a significantly lower incidence of contrast-induced nephropathy in the rosuvastatin group compared with the placebo group (6.7% vs. 15.1%; adjusted OR=0.38; 95% CI, 0.2-0.71). This finding persisted after application of different criteria for acute kidney injury and in higher-risk patients, such as those with baseline estimated creatinine clearance <60 mL per minute (adjusted OR=0.36; 95% CI, 0.15-0.87); in those who had a high-risk clinical profile (adjusted OR=0.44; 95% CI, 0.23-0.86); and in those who underwent PCI (adjusted OR=0.41; 95% CI, 0.19-0.89). The researchers also noted a significantly lower 30-day incidence of major adverse clinical events in the rosuvastatin group, as compared with the control group (3.6% vs. 7.9%; P=.036).
“In statin-naïve patients with non-ST elevation ACS scheduled for early invasive strategy, on-admission high-dose rosuvastatin exerts additional preventive effects against contrast-injury, when used with hydration and N-acetylcystein, and is associated with better short-term clinical outcomes,” Toso said.
“This study suggests that in [these patients], high-dose statins should be given on admission and in any case must precede the angiographic procedure in order to reduce renal complications after contrast medium administration.” – by Melissa Foster
For more information:
Toso A. Late-breaking clinical trials II: Interventional. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.
Disclosure: Toso reports no relevant financial disclosures.