Background Percutaneous coronary intervention (PCI)-induced myocardial damage is a major cause of late cardiovascular events. Treatment with atorvastatin before PCI can reduce myocardial damage during the peri-PCI period. Objectives: To compare the safety and myocardial effects of different atorvastatin loading doses and dosing frequency before PCI in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients.
Methods 80 NSTE-ACS patients were randomly divided into four groups (20 patients/group). The control group was given 40 mg atorvastatin each night. The three loading dose groups were treated as in the control group, but were given 80 mg atorvastatin 12 h before PCI (low-load group) in combination with 40 mg atorvastatin 2–4 h before PCI (mid-load group) or 60 mg atorvastatin 2–4 h before PCI (high-load group). All patients underwent PCI within 48–72 h of admission, and received 40 mg atorvastatin for at least 1 month after PCI. Changes in myocardial markers and high sensitive C-reactive protein (hs-CRP) were analysed. Patients were followed-up for 30 days to monitor the incidence of major adverse cardiac events (MACE).
Results No deaths or revascularisations were recorded. The incidences of MACE differed significantly between the four groups (40%, 25%, 10% and 0%, respectively, p<0.05). The incidence of MACE and cardiac troponin I (cTnI) level above the normal range, and post-PCI increases in creatine kinase-myocardial bank (CK-MB) and hs-CRP were significantly higher in the control group than in the high-load group (all, p<0.007). The post-PCI cTnI and CK-MB levels were similar to the pre-PCI levels in the high-load group, but increased significantly in the control and low-load groups. The magnitude of the hs-CRP level increased was significantly lower in the high-load group than in the control and low-load groups. The post-PCI alanine aminotransferase levels in all four groups were significantly higher than the pre-PCI levels, but were within normal ranges. No myalgia or myasthenia was observed.
Conclusion This study shows that short-term atorvastatin loading before PCI was well tolerated had beneficial myocardial effects in patients with NSTE-ACS.
- non-ST-segment elevation acute coronary syndrome
- interventional therapy