Korean Circ J.  2016 Jul;46(4):472-480. 10.4070/kcj.2016.46.4.472.

Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome?

• Lee BK
• Koo BK
• Nam CW
• Doh JH
• Chung WY
• Cho BR
• Fearon WF

• KMID: 2344421
• DOI: http://doi.org/10.4070/kcj.2016.46.4.472

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 kinase-myocardial 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.

Keyword

Acute coronary syndrome; Angioplasty; Statins; IMR; Microcirculation

MeSH Terms

Acute Coronary Syndrome*
Angioplasty
Atorvastatin Calcium*
C-Reactive Protein
Creatine
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Microcirculation
Percutaneous Coronary Intervention*
Prospective Studies
Stents
Atorvastatin Calcium
C-Reactive Protein
Creatine

Figure

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  Fig. 1 Study design and flow. ACS: acute coronary syndrome, PCI: percutaneous coronary intervention, CRP: C-reactive protein, CK-MB: creatine kinase-myocardial band, CK: creatine kinase, FFR: fractional flow reserve, DES: drug-eluting stent, IMR: index of microcirculatory resistance, CFR: coronary flow reserve, Pw: wedge pressure.

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  Fig. 2 Distribution of post-PCI IMR values among patients treated with and without high dose atorvastatin loading before PCI. IMR: index of microcirculatory resistance, PCI: percutaneous coronary intervention.

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  Fig. 3 Box plots comparing CK-MB levels before and after stenting in the two groups. The median, interquartile range (IQR) and 1.5 IQR for each group are shown. Comparison was performed by Man-Whitney and Wilcoxon tests. CK-MB: creatine kinase-myocardial isoenzyme, PCI: percutaneous coronary intervention.

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  Fig. 4 Scatterplots of the relationship between post-PCI IMR values and post-PCI CK-MB levels. PCI: percutaneous coronary intervention, IMR: index of microcirculatory resistance, CK-MB: creatine kinase-myocardial isoenzyme.

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