Twenty-one RCTs were included in the review (n=4,805 patients): 10 of PCI, eight of CABG and three of non-cardiac surgery. Trial quality was generally suboptimal. Few trials reported on blinding and randomisation.
Post-procedural myocardial infarction: When compared with control, post-procedural myocardial infarction was statistically significantly reduced by statin therapy (RR 0.57, 95% CI 0.46 to 0.70, I2=0%; 18 RCTs). Subgroup analysis revealed that results were statistically significant for PCI (RR 0.59, 95% CI 0.47 to 0.74, I2=0%; 10 RCTs) and non-cardiac surgery (RR 0.47, 95% CI 0.28 to 0.78, I2=0%; three RCTs) and were not significant with CABG. Results in the placebo-controlled trials showed a greater reduction in post-procedural myocardial infarction with statins compared with control (RR 0.43, 95% CI 0.30 to 0.61, I2=0%; nine RCTs).
Other outcomes: There was no statistically significant difference between statins and control in terms of all-cause mortality and repeat revascularisation. There was a statistically significantly greater incidence of atrial fibrillation in the control group compared with statin group in CABG patients (RR 0.54, 95% CI 0.43 to 0.68, I2=0%; six RCTs).
Meta-regression indicated evidence of heterogeneity based on pre-selected trial characteristics. There was no evidence of publication bias.