Comparative Efficacy of High-Dose Rosuvastatin and Atorvastatin in Preventing Cystatin C-Oriented Contrast-Induced Nephropathy in Patients With Acute Myocardial Infarction: RACCOON-AMI Registry.

IF 3 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Korean Medical Science Pub Date : 2025-04-14 DOI:10.3346/jkms.2025.40.e50

Ji Hye Kim, Hyunah Kim, Seung-Hyuk Choi, Woo Jeong Chun, Joon Hyung Doh, Jong-Young Lee, Seung-Jae Lee, Byung Jin Kim

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引用次数: 0

Abstract

Background: Prevention of contrast-induced nephropathy (CIN) is crucial in acute myocardial infarction (AMI) patients undergoing coronary interventions. Previous studies suggest that high-dose statins may aid in CIN prevention, yet comparative studies among different statin types using cystatin C (cysC) as a biomarker for CIN are absent. This study evaluated the effectiveness of high-dose rosuvastatin versus atorvastatin in preventing cysC-based CIN (cysC-CIN) in AMI patients.

Methods: This multicenter registry included 431 patients (rosuvastatin 20 mg: n = 231, atorvastatin 40 mg: n = 200). The primary endpoint was cysC-CIN incidence within 48 hours post contrast; the secondary endpoints were creatinine-based CIN (cr-CIN) incidence within 72 hours post contrast and post 30 days adverse events.

Results: The incidences of cysC-CIN (12.1% vs. 7.5%, P = 0.103) and cr-CIN (6.2% vs. 3.5%, P = 0.103) were higher in the atorvastatin group without significant statistical differences. Multivariable regression analysis, which was adjusted for CIN risk factors and the variables with univariate association, showed no increased odds ratio (OR) (OR, 2.185; 95% confidence interval [CI], 0.899, 5.315; P = 0.085) for cysC-CIN in the atorvastatin group compared to the rosuvastatin group. However, statin-naïve atorvastatin subgroup had significantly increased odds of cysC-CIN compared to the rosuvastatin group (OR, 2.977; 95% CI, 1.057, 8.378; P = 0.039). At post 30 days renal, cardiovascular, and mortality event rates were both low and similar between the two groups.

Conclusion: No significant difference in cysC-CIN incidence was found between the high-dose rosuvastatin and atorvastatin groups in AMI patients and cysC was more sensitive to the early detection of CIN than creatinine.

Trial registration: Clinical Research Information Service Identifier: KCT0003703.

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大剂量瑞舒伐他汀和阿托伐他汀预防急性心肌梗死患者胱抑素c定向造影剂肾病的比较疗效：RACCOON-AMI注册

背景：预防造影剂肾病（CIN）对急性心肌梗死（AMI）患者进行冠脉介入治疗至关重要。先前的研究表明，大剂量他汀类药物可能有助于预防CIN，但没有将胱抑素C （cystatin C, cysC）作为CIN生物标志物的不同类型他汀类药物之间的比较研究。本研究评估了大剂量瑞舒伐他汀与阿托伐他汀在AMI患者中预防cysC-CIN （cysC-CIN）的有效性。方法：该多中心注册包括431例患者（瑞舒伐他汀20mg: n = 231，阿托伐他汀40mg: n = 200）。主要终点是对比后48小时内cysC-CIN的发生率；次要终点是对比后72小时内基于肌酐的CIN （cr-CIN）发生率和30天后不良事件。结果：阿托伐他汀组cysC-CIN发生率（12.1% vs. 7.5%, P = 0.103）、cr-CIN发生率（6.2% vs. 3.5%, P = 0.103）较高，但差异无统计学意义。对CIN危险因素和单因素相关变量进行校正后的多变量回归分析显示，比值比（OR）没有增加(OR, 2.185；95%置信区间[CI]， 0.899, 5.315；P = 0.085)，阿托伐他汀组cysC-CIN与瑞舒伐他汀组比较。然而，statin-naïve阿托伐他汀亚组与瑞舒伐他汀组相比，cysC-CIN的发生率显著增加(OR, 2.977；95% ci, 1.057, 8.378；P = 0.039)。30天后，两组之间的肾脏、心血管和死亡事件发生率都很低且相似。结论：AMI患者高剂量瑞舒伐他汀组与阿托伐他汀组cysC-CIN发生率无显著差异，cysC对CIN的早期检测比肌酐更敏感。试验注册：临床研究信息服务标识：KCT0003703。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Korean Medical Science 医学-医学：内科

CiteScore

7.80

自引率

8.90%

发文量

320

审稿时长

3-6 weeks

期刊介绍： The Journal of Korean Medical Science (JKMS) is an international, peer-reviewed Open Access journal of medicine published weekly in English. The Journal’s publisher is the Korean Academy of Medical Sciences (KAMS), Korean Medical Association (KMA). JKMS aims to publish evidence-based, scientific research articles from various disciplines of the medical sciences. The Journal welcomes articles of general interest to medical researchers especially when they contain original information. Articles on the clinical evaluation of drugs and other therapies, epidemiologic studies of the general population, studies on pathogenic organisms and toxic materials, and the toxicities and adverse effects of therapeutics are welcome.