Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

• Published in: JACC. Cardiovascular interventions Vol. 3; no. 3; pp. 332 - 339
• Main Authors: Kim, Jung-Sun, MD, PhD, Kim, Jaedeok, MD, Choi, Donghoon, MD, PhD, Lee, Chan Joo, MD, Lee, Sang Hak, MD, PhD, Ko, Young-Guk, MD, Hong, Myeong-Ki, MD, PhD, Kim, Byoung-Keuk, MD, PhD, Oh, Seong Jin, MD, Jeon, Dong Woon, MD, Yang, Joo-Young, MD, PhD, Cho, Jung Rae, MD, Lee, Nam-Ho, MD, PhD, Cho, Yun-Hyeong, MD, Cho, Deok-Kyu, MD, Jang, Yangsoo, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-03-2010
• Subjects: acute myocardial infarction; Cardiovascular; percutaneous transluminal coronary angioplasty; statin; major adverse cardiac event; corrected thrombolysis in myocardial infarction frame count; CK-MB; emergency room; Thrombolysis In Myocardial Infarction; STR; electrocardiogram; percutaneous coronary intervention; acute coronary syndrome; MBG; percutaneous transluminal coronary angioplasty; MACE; myocardial blush grade; STEMI; creatine kinase-myocardial band; cTFC; ECG; ER; ACS; statin; TIMI; PCI; ST-segment resolution; ST-segment elevation myocardial infarction; acute myocardial infarction
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2009.11.021

Objectives This study sought to determine the efficacy of high-dose atorvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Background Previous randomized trials have demonstrated that statin pre-treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, no randomized studies have been carried out with STEMI patients in a primary PCI setting. Methods A total 171 patients with STEMI were randomized to 80-mg atorvastatin (n = 86) or 10-mg atorvastatin (n = 85) arms for pre-treatment before PCI. All patients were prescribed clopidogrel (600 mg) before PCI. After PCI, both groups were treated with atorvastatin (10 mg). The primary end point was 30-day incidence of MACE including death, nonfatal MI, and target vessel revascularization. Secondary end points included corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, and ST-segment resolution at 90 min after PCI. Results MACE occurred in 5 (5.8%) and 9 (10.6%) patients in the 80-mg and 10-mg atorvastatin pre-treatment arms, respectively (p = 0.26). Corrected thrombolysis in myocardial infarction frame count was lower in the 80-mg atorvastatin arm (26.9 ± 12.3 vs. 34.1 ± 19.0, p = 0.01). Myocardial blush grade and ST-segment resolution were also higher in the 80-mg atorvastatin arm (2.2 ± 0.8 vs. 1.9 ± 0.8, p = 0.02 and 61.8 ± 26.2 vs. 50.6 ± 25.8%, p = 0.01). Conclusions High-dose atorvastatin pre-treatment before PCI did not show a significant reduction of MACEs compared with low-dose atorvastatin but did show improved immediate coronary flow after primary PCI. High-dose atorvastatin may produce an optimal result for STEMI patients undergoing PCI by improving microvascular myocardial perfusion. (Efficacy of High-Dose AtorvaSTATIN Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction [STATIN STEMI]; NCT00808717 ).