Objectives To evaluate the protective effects of higher dose statin on renal function and the incidence of CIN.
Methods 228 patients with acute coronary syndrome undergoing delayed percutaneous coronary intervention were randomly divided into standard statin group (SSG n=115) and intensive statin group (ISG n=113). Patients in SSG were given simvastatin 20 mg/day and patients in ISG were given simvastatin 80 mg/day for at least 7 days before PCI, Serum creatinine was measured at admission, 24 h and 48 h after PCI, and the Creatinine clearance was calculated. The levels of hs-CRP, ICAM-1 and P-selectin were also measured.
Results Serum creatinine underwent significant increase after PCI, the peak value occurred at 24 h, and then began to decrease. At 48 h after PCI, the creatinine level significantly decreased (p<0.001) to baseline level in ISG, whereas in SSG the creatinine level failed to decrease significantly. Serum creatinine at admission was not significantly different between the two groups, But at 24th and 48th hour after PCI, it were lower in ISG than SSG (p<0.05 at 24th hour and p<0.001 at 48th hour). The creatinine clearance significantly decreased after PCI, the lowest value occurred at 24 h, and then it began to increase. In SSG, the creatinine clearance increased significantly (p=0.03) at 48 h, but still significantly lower than baseline level. In ISG, the creatinine clearance increased significantly (p<0.001) at 48 h and recovered to the level at baseline. Creatinine clearance improved much more in ISG at 24 and 48 h than that in SSG (p<0.001 at 24th hour and at 48th hour). Although procedure caused significant increase in hs-CRP, P-selectin and ICAM-1 (p<0.001), the increase in ISG was smaller than SSG (p<0.001).
Conclusion Pretreatment with intensive statin dosage before PCI can further decrease the occurrence of CIN. This benefit may be associated with the lowering of hs-CRP, P-selectin and ICAM levels.