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Korean Circ J. 2016 Jul;46(4):472-480. English. Original Article. https://doi.org/10.4070/kcj.2016.46.4.472
Lee BK , Koo BK , Nam CW , Doh JH , Chung WY , Cho BR , Fearon WF .
Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Korea.
Division of Cardiology, Seoul National University Hospital, Seoul, Korea. bkkoo@snu.ac.kr
Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea.
Division of Cardiology, Inje University Ilsan-Paik Hospital, Goyang, Korea.
Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
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.

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