ISSN 2996-8215
International Journal of Cardiology | Vol. 11, No. 1, January 2020 | pp. 1–8
DOI: 10.46882/2020/IJC/000130
Original Research Article
High-Dose Atorvastatin Reloading Safeguards Against Periprocedural Myocardial Infarction During Complex Percutaneous Coronary Intervention
Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²
¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
²Division of Interventional Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
Abstract:
Periprocedural myocardial infarction (pMI) frequently complicates complex percutaneous coronary intervention (PCI), worsening long-term outcomes. Acute statin loading reduces myonecrosis in statin-naive patients, but its cardioprotective efficacy during complex interventions in patients already receiving long-term maintenance statins requires validation. This prospective, randomized, open-label clinical trial investigated whether high-dose atorvastatin reloading before complex PCI reduces pMI in patients on chronic statin therapy. We enrolled 240 chronic statin users scheduled for complex PCI (defined as multi-vessel intervention, bifurcation lesions, or chronic total occlusions). Patients were randomized 1:1 to receive an acute reload of atorvastatin (80 mg administered 12 hours and 2 hours pre-PCI, n = 120) or to continue standard maintenance dosing alone (n = 120). The primary endpoint was the incidence of pMI, defined as an elevation of cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours post-procedure. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the maintenance control group (8.3% vs. 17.5%, p = 0.03). Post-procedural mean cTnI values were also significantly lower in the reloaded cohort (0.44 ± 0.12 ng/mL vs. 0.92 ± 0.22 ng/mL, p < 0.01). No cases of acute hepatic impairment or rhabdomyolysis were reported. High-dose atorvastatin reloading safely and significantly protects against periprocedural myocardial injury during complex percutaneous coronary intervention in patients established on chronic maintenance statin therapy.
Keywords: Percutaneous coronary intervention, Atorvastatin, Statin reloading, Periprocedural myocardial infarction, Complex coronary lesions, Cardioprotection
Received: October 12, 2019; Revised: November 24, 2019; Accepted: December 15, 2019; Published: January 18, 2020