J Korean Med Sci.  2025 Apr;40(14):e50. 10.3346/jkms.2025.40.e50.

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

• Kim JH
• Kim H
• Choi SH
• Chun WJ
• Doh JH
• Lee JY
• Lee SJ
• Kim BJ

• KMID: 2566830
• DOI: http://doi.org/10.3346/jkms.2025.40.e50

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 highdose rosuvastatin and atorvastatin groups in AMI patients and cysC was more sensitive to the early detection of CIN than creatinine.

Keyword

Cystatin C; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Myocardial Infarction; Contrast Induced Nephropathy; Rosuvastatin; Atorvastatin

Figure

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  Fig. 1 Flow chart of study design.

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  Fig. 2 Incidences of cystatin C-based and creatinine-based contrast induced nephropathy. (A) Incidences of cysC-CIN and cr-CIN at 24-, 48, and 72-hour post contrast exposure in the overall population. (B) Incidences of cysC-CIN and cr-CIN between atorvastatin and rosuvastatin groups.Data are shown as below: CysC-CIN: increase in serum cysC ≥ 0.5 mg/dL or ≥ 25% from the baseline within 48 hours after contrast media exposure; Cr-CIN: increase in serum cr ≥ 0.5 mg/dL or ≥ 25% from the baseline within 72 hours after contrast media exposure.CIN = contrast induced nephropathy, cysC-CIN = cystatin C-based contrast induced nephropathy, cr-CIN = creatinine-based contrast induced nephropathy.

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