There is still an ongoing debate about the role of statin therapy prior to PCI. Generally, all pts with CAD should be treated with statins. However, it is not clear whether PCI has to be postponed because of pretreatment with statins. Our RCTs demonstrated absence of any effect of this pre-PCI therapy.
You are quite right, only two randomized studies demonstrated such a protective effect while many others no (also according to my personal unpublished data), and the physiopathological explanation of such a RAPID protective effect is poor. I think it is wise to give statins to elective PCI patients because they have CAD, but the only reason to postpone PCI according to my personal point of view is the discovery of very complex lesions with thrombus (often bypass grafts) were a pretreatment with aggressive antiplatelet therapy and statins might be reasonable. I think that a multicenter collaborative data collection or even better a large multicenter randomized study performed by "independent" researchers should be done (why do not plan this together ?)
It is a good question regarding pretreatment of statins in postponed PCI in stable CAD subjects. Despite negative results of recent clinical trials it is reasonable to assume that statin use can probably prevent atherothrombotic events after PCI in follow-up. One of another aspect is whether pre treatment with statins prevent contrast-induced nephropathy in stable CAD subjects required PCI? If yes, what kind of effect regarding survival might have pretreatment of statins?
I agree with Alessandro Lupi. Postponing Elective PCI for preteatment with statins may not bev warranted. Elective PCI may be postponed for aggressive antiplatelet and statin ttherapy in patients with high thrombus burden.
In the absence of evidence, common sense still remains helpful. Truly stable patients are less likely to present with acute coronary syndrome. These patients are usually seen in the outpatient department and if not already on statins due to co morbidities such as diabetes they will be started at that time and listed for coronary angiography, possibly with a view to PCI. If these patients attend for their procedure they will have been on statins for several weeks. There shouldn't be a large thrombus burden, but if there is for any reason you deal with this at the time, possibly with more aggressive anti platelet therapy such as GPI. Patients who present with ACS and are likely to have high thrombus burden are obviously not categorised as stable and therefore benefit from early revascularisation and initiation of high dose statin.