Objective  To systematically evaluate the efficacy of loading dose rosuvastatin before percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).

Methods  Pubmed, Embase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials and prospective cohort studie with or without preoperative administration of loading-dose rosuvastatin in ACS patients undergoing PCI from inception to October 31st, 2022. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using Stata 12.0 software.

Results  A total of 19 studies involving 3 201 participants were included in the study. The results of meta-analysis showed that preoperative loading dose of rosuvastatin could significantly reduce postoperative major cardiovascular events (MACE) (RR=0.40, 95%CI 0.32 to 0.49, P<0.001), myocardial infarction (MI) (RR=0.46, 95%CI 0.35 to 0.60, P<0.001) and all-cause mortality (ACM) (RR=0.31, 95%CI 0.13 to 0.72, P=0.006) in patients compared with no preoperative statin. According to the follow-up time, there were statistically significant differences in MACE between the two groups during hospitalization, 30 days, 3 months, 6 months and 1 year after surgery (P<0.05). The risk of MI in the preperative loading dose of rosuvastation group was significantly lower than that in the no preperative stain group at 30 days after operation (RR=0.48, 95%CI 0.37 to 0.64, P<0.001), but there was no significant difference in other follow-up time points between the two groups. There was no significant difference in ACM risk between the two groups in each subgroup (P>0.05).

Conclusions  Preoperative loading dose of rosuvastatin can reduce the risk of MACE, MI and ACM in ACS patients after PCI. However, due to the lack of data at some follow-up time points, more high quality studies are required to verify the above conclusion.

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