ISSN 2996-8215
International Journal of Cardiology | Vol. 7, No. 12, December 2016 | pp. 89–96
DOI: 10.46882/2016/IJC/000093
Original Research Article
Clinical Utility of Acute High-Dose Atorvastatin Reloading Prior to Percutaneous Coronary Intervention
Yusuf Demir¹, Murat Kaya¹, Ahmet Yilmaz²
¹Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
²Division of Cardiovascular Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
Abstract:
Preprocedural statin loading reduces perioperative myocardial injury in statin-naive individuals undergoing percutaneous coronary intervention (PCI). However, the therapeutic value of acute high-dose statin reloading in patients already established on long-term maintenance statin therapy remains less defined. This prospective, randomized, open-label trial evaluated whether an acute high-dose atorvastatin reload prior to scheduled PCI minimizes periprocedural myocardial infarction (pMI) in patients on chronic statin treatment. We enrolled 260 patients with stable coronary disease or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who had been taking standard maintenance statins continuously for greater than 30 days. Patients were randomized 1:1 to receive either an acute reload of atorvastatin (80 mg administered 12 hours and 2 hours before PCI, n = 130) or to continue their standard maintenance regimen alone (n = 130). The primary endpoint was the incidence of pMI, defined as a post-procedural elevation of serum cardiac troponin I (cTnI) greater than 5 times the upper limit of normal within 24 hours of intervention. The incidence of pMI was significantly lower in the atorvastatin reloading group than in the maintenance control group (7.7% vs. 16.2%, p = 0.03). Mean post-procedural cTnI levels were also significantly reduced in reloaded patients (0.42 ± 0.15 ng/mL vs. 0.88 ± 0.24 ng/mL, p < 0.01). Acute hepatic dysfunction and rhabdomyolysis were completely absent in both cohorts. High-dose atorvastatin reloading safely and significantly reduces periprocedural myocardial injury in patients undergoing PCI, even when they are already established on chronic maintenance statin therapy.
Keywords: Percutaneous coronary intervention, Atorvastatin, Statin loading, Periprocedural myocardial infarction, Stable angina, Acute coronary syndrome
Received: September 05, 2016; Revised: October 20, 2016; Accepted: November 12, 2016; Published: December 18, 2016