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Comparing common doses (double-dose vs usual-dose) of atorvastatin for preventing contrast-induced acute kidney injury and mortality after coronary angiography.

Abstract High-dose atorvastatin pretreatment was proved reducing the risk of contrast-induced acute kidney injury (CI-AKI), especially in patients with high C-reactive protein (CRP) levels. We evaluated the effects of common atorvastatin doses (double vs usual) on the risk of CI-AKI and mortality.We recorded outcomes from 1319 patients who were administered periprocedural common doses of atorvastatin. The risks of CI-AKI and mortality between double-dose (40 mg/d) and usual-dose atorvastatin (20 mg/d) were compared using multivariable regression models in all patients or CRP tertile subgroups.Seventy-six (5.8%) patients developed CI-AKI. Double-dose atorvastatin compared with usual-dose did not further reduce the risk of CI-AKI (adjusted odds ratio [OR]: 2.28, 95% confidence interval [CI]: 0.92-5.62, P = .074), even for patients in the highest CRP tertile (>8.33 mg/L; adjusted OR: 3.76, 95% CI: 0.83-17.05, P = .086). Similar results were observed in reducing mortality in all patients (adjusted hazard ratio: 0.47, 95% CI: 0.10-2.18; P = .339) and in the highest CRP tertiles (P = .424). In the subgroup analysis, double-dose atorvastatin increased risk of CI-AKI in patients with creatinine clearance (CrCl) < 60 mL/min, anemia, contrast volume > 200 mL and > 2 stents implanted (P = .046, .009, .024, and .026, respectively).Daily periprocedural double-dose atorvastatin was not associated with a reduced risk of CI-AKI compared with usual-dose, and did not provide an improved long-term prognosis, even in patients with high CRP levels. However, it increased the risk of CI-AKI in patients with a high contrast volume/CrCl.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28746193
OWN - NLM
STAT- In-Process
DA  - 20170726
LR  - 20170726
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 30
DP  - 2017 Jul
TI  - Comparing common doses (double-dose vs usual-dose) of atorvastatin for preventing
      contrast-induced acute kidney injury and mortality after coronary angiography.
PG  - e7501
LID - 10.1097/MD.0000000000007501 [doi]
AB  - High-dose atorvastatin pretreatment was proved reducing the risk of
      contrast-induced acute kidney injury (CI-AKI), especially in patients with high
      C-reactive protein (CRP) levels. We evaluated the effects of common atorvastatin 
      doses (double vs usual) on the risk of CI-AKI and mortality.We recorded outcomes 
      from 1319 patients who were administered periprocedural common doses of
      atorvastatin. The risks of CI-AKI and mortality between double-dose (40 mg/d) and
      usual-dose atorvastatin (20 mg/d) were compared using multivariable regression
      models in all patients or CRP tertile subgroups.Seventy-six (5.8%) patients
      developed CI-AKI. Double-dose atorvastatin compared with usual-dose did not
      further reduce the risk of CI-AKI (adjusted odds ratio [OR]: 2.28, 95% confidence
      interval [CI]: 0.92-5.62, P = .074), even for patients in the highest CRP tertile
      (&gt;8.33 mg/L; adjusted OR: 3.76, 95% CI: 0.83-17.05, P = .086). Similar results
      were observed in reducing mortality in all patients (adjusted hazard ratio: 0.47,
      95% CI: 0.10-2.18; P = .339) and in the highest CRP tertiles (P = .424). In the
      subgroup analysis, double-dose atorvastatin increased risk of CI-AKI in patients 
      with creatinine clearance (CrCl) &lt; 60 mL/min, anemia, contrast volume &gt; 200 mL
      and &gt; 2 stents implanted (P = .046, .009, .024, and .026, respectively).Daily
      periprocedural double-dose atorvastatin was not associated with a reduced risk of
      CI-AKI compared with usual-dose, and did not provide an improved long-term
      prognosis, even in patients with high CRP levels. However, it increased the risk 
      of CI-AKI in patients with a high contrast volume/CrCl.
FAU - Bei, Wei-Jie
AU  - Bei WJ
AD  - aDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong
      provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General
      Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong bDepartment
      of Biostatistics, South China College of Cardiovascular Research, Guangdong
      Society of Interventional Cardiology, Guangzhou cState Key Laboratory of Organ
      Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou
      dDepartment of Biostatistics, School of Public Health, Southern Medical
      University, Guangzhou, China.
FAU - Chen, Shi-Qun
AU  - Chen SQ
FAU - Li, Hua-Long
AU  - Li HL
FAU - Wu, Deng-Xuan
AU  - Wu DX
FAU - Duan, Chongyang
AU  - Duan C
FAU - Chen, Ping-Yan
AU  - Chen PY
FAU - Chen, Ji-Yan
AU  - Chen JY
FAU - Tan, Ning
AU  - Tan N
FAU - Xie, Nian-Jin
AU  - Xie NJ
FAU - Liu, Yong
AU  - Liu Y
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/07/27 06:00
MHDA- 2017/07/27 06:00
CRDT- 2017/07/27 06:00
AID - 10.1097/MD.0000000000007501 [doi]
AID - 00005792-201707280-00024 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(30):e7501. doi: 10.1097/MD.0000000000007501.