Effect of high-dose rosuvastatin loading before percutaneous coronary intervention in Chinese patients with acute coronary syndrome: A systematic review and meta-analysis

BackgroundAcute coronary syndrome (ACS) is an important disease threatening human life and health. Many studies have shown that the loading dose of atorvastatin can significantly improve the prognosis of patients with ACS, and reduce the mortality. However, this conclusion is not consistent. Thus, we aimed to evaluate the effect of high-dose rosuvastatin loading before percutaneous coronary intervention (PCI) in Chinese patients with ACS using a meta-analysis based on a systematic review of published articles.MethodsWe systematically reviewed published studies, evaluating the effect of high-dose rosuvastatin loading before percutaneous coronary intervention in Chinese patients with ACS. The retrieval time is limited from inception to 2 November 2016, and the retrieved databases included PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, the VIP database and the Wang Fang database. Two researchers independently assessed the quality of the included studies and then extracted the data. Stata 11.0 was used for data analysis.ResultsIn total, 11 articles, which included 802 patients, were included in our meta-analysis. Among these patients, 398 patients were in the high-dose group (20 mg/day) and 404 patients were in the conventional dose group (10 mg/day). Meta-analysis results showed that compared with the conventional dose group: 1) The loading dose of rosuvastatin can significantly reduce the hs-CRP level after PCI, including at 24 hours (SMD = -0.65, 95%CI -0.84 ~ -0.47, P = 0.000), 48 hours (SMD = -0.40, 95%CI -0.68 ~ -0.11, P = 0.006), and four weeks (SMD = -1.64, 95%CI -2.01 ~ -1.26, P = 0.000). 2) The loading dose of rosuvastatin can significantly reduce the levels of LDL-C and cTnT, including the level of LDL-C at 30 d after PCI (SMD = -0.89, 95%CI -1.10 ~ -0.69, P = 0.000), and the level of cTnT at 24 h after PCI (SMD = -1.93, 95%CI -2.28 ~ -1.59, P = 0.000), and increase the level of HDL-C at 48 h after PCI (SMD = 0.61, 95%CI 0.34 ~ 0.88, P = 0.000). 3) The loading dose of rosuvastatin can significantly reduce the levels of TG and TC, including the level of TG at 30 d after PCI (SMD = -0.94, 95%CI -1.17 ~ -0.71, P = 0.000), the level of TC at 48 h after PCI (SMD = -0.35, 95%CI -0.68 ~ -0.01, P = 0.043), and the level of TC at 30 d after PCI (SMD = -0.77, 95%CI -0.98 ~ -0.56, P = 0.000).ConclusionsOur systematic review and meta-analysis showed that, compared with the conventional dose, the loading dose of rosuvastatin was more beneficial to patients with ACS in China and is suitable for clinical application. Due to the limitations of the quality and quantity of included articles, this conclusion still needs to be confirmed by multicenter clinical trials.

**背景** 急性冠状动脉综合征（ACS）是一类严重威胁人类生命健康的疾病。既往多项研究表明，阿托伐他汀负荷剂量可显著改善ACS患者的预后并降低病死率，但该结论尚未达成统一共识。本研究旨在通过对已发表文献进行系统评价后开展荟萃分析，评估经皮冠状动脉介入治疗（PCI）前给予高剂量瑞舒伐他汀对中国ACS患者的临床疗效。

**方法** 本研究系统检索了评估中国ACS患者PCI术前高剂量瑞舒伐他汀负荷治疗疗效的已发表文献，检索时限为建库至2016年11月2日，检索数据库包括PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普数据库及万方数据库。由2名研究者独立对纳入研究的质量进行评价并提取数据，采用Stata 11.0统计软件进行数据分析。

**结果** 本荟萃分析共纳入11项符合标准的研究，合计802例患者，其中高剂量组（20mg/d）398例，常规剂量组（10mg/d）404例。荟萃分析结果显示，与常规剂量组相比：1）瑞舒伐他汀负荷剂量可显著降低PCI术后患者的高敏C反应蛋白（hs-CRP）水平，包括术后24小时（标准化均数差SMD=-0.65，95%置信区间CI：-0.84~-0.47，P=0.000）、术后48小时（SMD=-0.40，95%CI：-0.68~-0.11，P=0.006）及术后4周（SMD=-1.64，95%CI：-2.01~-1.26，P=0.000）；2）瑞舒伐他汀负荷剂量可显著降低低密度脂蛋白胆固醇（LDL-C）及心肌肌钙蛋白T（cTnT）水平，具体包括PCI术后30天的LDL-C水平（SMD=-0.89，95%CI：-1.10~-0.69，P=0.000）、PCI术后24小时的cTnT水平（SMD=-1.93，95%CI：-2.28~-1.59，P=0.000），同时可升高PCI术后48小时的高密度脂蛋白胆固醇（HDL-C）水平（SMD=0.61，95%CI：0.34~0.88，P=0.000）；3）瑞舒伐他汀负荷剂量可显著降低甘油三酯（TG）及总胆固醇（TC）水平，具体包括PCI术后30天的TG水平（SMD=-0.94，95%CI：-1.17~-0.71，P=0.000）、PCI术后48小时的TC水平（SMD=-0.35，95%CI：-0.68~-0.01，P=0.043）及PCI术后30天的TC水平（SMD=-0.77，95%CI：-0.98~-0.56，P=0.000）。

**结论** 本系统评价及荟萃分析结果表明，与常规剂量相比，瑞舒伐他汀负荷剂量更有益于中国ACS患者，适合临床推广应用。但受纳入研究的质量与数量限制，该结论仍需多中心临床试验进一步验证。