Iodine does not mediate seafood, shellfish, or contrast media reactions. The common misconception that seafood allergies and contrast reactions are cross-reactions to iodine probably arose from a survey published in 1975 in which 15% of patients with a history of contrast reaction reported a personal history of shellfish allergy, but nearly identical proportions of patients reported allergies to other foods, such as milk and egg, in the same survey.287 Pretreatment of patients with steroids based only on a history of seafood or shellfish allergy has a small but non-zero risk of adverse effect (eg, hyperglycemia in a patient with diabetes) without any demonstrated benefit.288,289 4.6. Statin Treatment: Recommendation Class IIa 1. Administration of a high-dose statin is reasonable before PCI to reduce the risk of periprocedural MI. (Level of Evidence: A for statin-na ve patients290 296; (Level of Evidence: B for those on chronic statin See Online Data Supplement 19 for additional data regarding preprocedural statin treatment. Statins have long-term benefits in patients with CAD343,344 and ACS.345,346 The benefits of statins in ACS begin early, before substantial lipid lowering has oc- curred,345,347 suggesting pleiotropic effects of statins. These might include anti-inflammatory effects, improve- ment of endothelial function, decrease of oxidative stress, or inhibition of thrombogenic responses.348 Statins were beneficial when pretreatment was started from 7 days to 4.7. Bleeding Risk: Recommendation Class I 1. All patients should be evaluated for risk of bleeding before PCI. (Level of Evidence: C) Periprocedural bleeding is now recognized as a major risk factor for subsequent mortality.265,266 Bleeding may lead to mortality directly (because of the bleeding event) or through ischemic complications that occur when antiplatelet or anti- coagulant agents are withdrawn in response to the bleeding. Bleeding may also be a marker of comorbidities associated with worse prognosis (eg, occult cancer). 