In a study presented at the American College of Cardiology conference last month (PRATO-ACS), rosuvastatin significantly reduced the risk of contrast-induced nephropathy in the setting of NSTEMI. Statin-naive patients with NSTEMI were randomized to receive rosuvastatin (40mg on admission then 20mg daily indefinitely) or atorvastatin only after discharge. Patients in the rosuvastatin group had a lower incidence of CIN (6.7% vs 15.1%), defined as 25% or 0.5mg/dl increase in serum creatinine within 72 hours of contrast exposure. Rosuvastatin is non-formulary at LVHN, but it seems likely to be a class effect so other statins could probably be substituted.
Thanks to Henry Schairer for calling my attention to this study.
Interesting and good to know! but I would review indepth about this statins for CIN. Not sure if this is a double blind study, how much hydration in each group and amouunt of IV contrast used in each group. Some centers start statins at the time of diagnosis of NSTEMI/STEMI (I remember starting in my patients during my training). As per Uptodate " Statin therapy should be instituted prior to hospital discharge, with some data supporting initiation at the time of diagnosis [1]. We recommend therapy with atorvastatin 80 mg/day, which was used in the PROVE IT-TIMI 22 and MIRACL trials ". Not sure what our cardiology colleagues are practicing now.
ReplyDeleteThis study focused on pts with NSTEMI, but statins may end up being protective against CIN in other clinical settings in which statins are already not standard of care (ie, elective cath, CT with contrast in high-risk patients). Will need more data to be sure, but given low risk of treatment (and large potential risk reduction) it might be reasonable to use statins in these settings.
ReplyDelete