Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome?
- Affiliated Author(s)
- 남창욱
- Alternative Author(s)
- Nam, Chang Wook
- Journal Title
- Korean Circulation Journal
- ISSN
- 1738-5520
- Issued Date
- 2016
- Keyword
- Acute coronary syndrome; Angioplasty; Statins; IMR; Microcirculation
- Abstract
- Background and Objectives: There is controversy surrounding whether or not high dose statin administration before percutaneous
coronary intervention (PCI) decreases peri-procedural microvascular injury. We performed a prospective randomized study to investigate
the mechanisms and effects of pre-treatment high dose atorvastatin on myocardial damage in patients with non-ST-segment elevation
acute coronary syndrome (NSTE-ACS) undergoing PCI.
Subjects and Methods: Seventy seven patients with NSTE-ACS were randomly assigned to either the high dose group (atorvastatin 80 mg
loading 12 to 24 h before PCI with a further 40 mg loading 2 h before PCI, n=39) or low dose group (atorvastatin 10 mg administration
12 to 24 h before PCI, n=38). Index of microcirculatory resistance (IMR) was measured after stent implantation. Creatine kinasemyocardial
band (CK-MB) and high sensitivity C-reactive protein (CRP) levels were measured before and after PCI.
Results: The baseline characteristics were not different between the two patient groups. Compared to the low dose group, the high dose
group had lower post PCI IMR (14.1±5.0 vs. 19.2±9.3 U, p=0.003). Post PCI CK-MB was also lower in the high dose group (median: 1.40
ng/mL (interquartile range [IQR: 0.75 to 3.45] vs. 4.00 [IQR: 1.70 to 7.37], p=0.002) as was the post-PCI CRP level (0.09 mg/dL [IQR: 0.04 to
0.16] vs. 0.22 [IQR: 0.08 to 0.60], p=0.001).
Conclusion: Pre-treatment with high dose atorvastatin reduces peri-PCI microvascular dysfunction verified by post-PCI IMR and exerts an
immediate anti-inflammatory effect in patients with NSTE-ACS.
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