Trial reportJAMA2018
Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.
Trial report in JAMA, 2018. The graph read 2 numbers from its abstract, feeding 1 cell of the map: it finds no clear difference in 1. An erratum has been issued. It reports registered trial NCT01448642. Cited by 65 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
Ratios
At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27).
Differences
At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27).
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Where it lands on the map
Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.
What it adds to each cell
For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.
Statins×cardiovascular events
InconclusiveOpen on the map →What to test next →30 readable studies in this cell: 16 favour the treatment, 12 find no difference, 2 favour the comparator.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized, Multicenter Clinical Trial to Assess the Effect of Atorvastatin in Patients With Acute Coronary Syndrome and Intended Percutaneous Coronary Intervention
Open the trial in the graphWho cites it
65 citing papers in PubMed, 5 syntheses or guidelines pooled it, 132 citations in OpenAlex.
- Atorvastatin before percutaneous coronary intervention: A systematic review and meta-analysis.PloS one · 2024Pooled it
- Pooled it
- Meta-Analysis of Intensive Lipid-Lowering Therapy in Patients With Polyvascular Disease.Journal of the American Heart Association · 2021Pooled it
- Effect of loading dose of atorvastatin therapy prior to percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of six randomized controlled trials.Drug design, development and therapy · 2019 · on this mapPooled it
- Efficacy Evaluation of High-Dose Atorvastatin Pretreatment in Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials.Medical science monitor : international medical journal of experimental and clinical research · 2018Pooled it
- Risk stratification of ST-segment elevation myocardial infarction (STEMI) patients using machine learning based on lipid profiles.Lipids in health and disease · 2021Trial
- Ezetimibe Improves Rosuvastatin Effects on Inflammation and Vascular Endothelial Function in Acute Coronary Syndrome Patients Undergoing PCI.Journal of interventional cardiology · 2021Trial
- Statin Short-term Inhibition of Insulin Sensitivity and Secretion During Acute Phase of ST-Elevation Myocardial Infarction.Scientific reports · 2019 · on this mapTrial
- Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial.European heart journal · 2019Trial
- Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: Insights From the SECURE-PCI Randomized Clinical Trial.JAMA cardiology · 2018Trial
- Optimal Medical Therapy Targeting Lipids and Inflammation for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention.Journal of clinical medicine · 2025Review
- Targeted Theranostic Strategy for Atherosclerotic Plaques Using Intravascular Multimodal Imaging Techniques.Journal of lipid and atherosclerosis · 2025Review
- Short-term effects of PCSK-9 inhibitors on percutaneous coronary intervention in patients with acute coronary syndrome.The Korean journal of internal medicine · 2025Article
- Article
- Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention.Cardiovascular diagnosis and therapy · 2024Article
- Role of statins in the management of dyslipidaemia.Indian heart journal · 2024Review
- Treatment of dyslipidemia in acute coronary syndrome.Indian heart journal · 2024Review
- Commencement of Atorvastatin and Ezetimibe Immediately in Patients Presenting with Acute Coronary Syndrome.European cardiology · 2024Review
- The Serial Mediation Effects of Social Support and Self-Efficacy on Health Literacy and Self-Management Behaviors Among Young and Middle-Aged Cardiac Patients After Percutaneous Coronary Intervention: A Cross-Sectional Study in China.Risk management and healthcare policy · 2024Article
- Longitudinal change of serum exosomal miR-186-5p estimates major adverse cardiac events in acute myocardial infarction patients receiving percutaneous coronary intervention.Frontiers in cardiovascular medicine · 2024Article
5 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
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- Erratum issuedError in Figure.2018
Authors and funding
35 authors at 14 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The marked sentences are the ones the graph read a number from.
Importance: The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. Objective: To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. Interventions: Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. Main Outcomes and Measures: The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. Results: Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. Conclusions and Relevance: Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use of loading doses of atorvastatin among unselected patients with ACS and intended invasive management. Trial Registration: clinicaltrials.gov Identifier: NCT01448642.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.