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High-dose statin before PCI decreases periprocedural MI risk
Loading or reloading with high-dose atorvastatin reduces the risk of periprocedural myocardial infarction (MI) and vascular events in patients undergoing elective percutaneous coronary intervention (PCI), according to data presented at the American College of Cardiology 58th Annual Scientific Session.
In a loading study, atorvastatin 80 mg administered within 24 hours of PCI to statin-naïve patients reduced the risk of periprocedural non-Q-wave MI by 44%, reported Carlo Briguori, MD, PhD, of Clinica Mediterranea, Naples, Italy.
Up to 30% of untreated patients have increases in troponin and creatine kinase-myocardial band (CK-MB) levels after stent implantation, Dr Briguori said.
In this study, 668 statin-naïve patients scheduled for elective PCI were randomized to receive either atorvastatin 80 mg or placebo.
The incidence of periprocedural MI, defined as an elevation of CK-MB>3 times the upper limit of normal (ULN) with or without ST segment or T-wave abnormalities, was 9.5% in patients treated with atorvastatin and 15.8% in patients treated with placebo (P=.014). The incidence of troponin elevation>3 times ULN was also significantly reduced with atorvastatin treatment (atorvastatin, 26.6%; placebo, 39.1%; P<.001).
The clinical significance of preventing periprocedural increases of cardiac enzyme levels>3 times ULN is unclear, as data are needed to understand whether such MIs are associated with long-term left ventricular dysfunction.
Similar results with atorvastatin reloading were obtained in a study of patients who were already being treated with chronic statin therapy at the time of PCI. In this study, investigators observed that reloading with atorvastatin 80 mg 12 hours before PCI followed by a 40-mg preprocedural dose reduced the relative risk of major adverse cardiac events (MACE) by 48% at 30 days.
This study included 352 patients with either stable angina or non-ST-elevation acute coronary syndromes who had been taking a statin for at least 30 days. A total of 55% of the patients were taking atorvastatin at baseline, albeit at lower doses.
At 30 days, 3.4% of the atorvastatin group and 9.1% of the control group had suffered MACE (P=.045), yielding 17 as the number needed to treat to prevent 1. The occurrence of MI was reduced from 8.6% in the control group to 3.4% in the atorvastatin group.
“The benefit was highly localized to patients presenting with unstable acute coronary syndromes,” said the study’s lead investigator, Germano DiSciascio, MD, professor and chairman of cardiology, and director of cardiovascular sciences, University of Rome, Italy. These patients demonstrated a MACE incidence of 2.4% compared with 13.8% among control patients (P=.016).