Preprocedural Statin Medication Reduces the Extent of Periprocedural Non-Q-Wave Myocardial Infarction - Preprocedural Statin Medication Reduces the Extent of Periprocedural Non-Q-Wave Myocardial Infarction

Description:

The goal of this study was to assess the safety and efficacy of preprocedural statin therapy among patients undergoing stenting of a de novo stenosis.

Study Design

Study Design:

Patients Enrolled: 296

Drug/Procedures Used:

The study design was a retrospective cohort study. The investigators divided 296 consecutive patients who were undergoing stenting of a de novo stenosis according to the preprocedural status of statin therapy (229 statin-treated and 67 control patients). The incidence of periprocedural myocardial injury was assessed by analysis of creatine kinase (CK; upper limit of normal [ULN] 70 IU/L for women, 80 IU/L for men) and cardiac troponin T (cTnT; bedside test; threshold 0.1 ng/mL) before and 6, 12, and 24 hours after the coronary intervention.

Principal Findings:

Compared to control patients, the incidence of CK elevation > 3x ULN was more than 90% lower in statin-treated patients (0.4% versus 6.0%, P=0.01). Statin therapy was the only factor independently associated with a lower risk of CK elevation > 3x ULN (OR: 0.08, 95% CI: 0.01 to 0.75; P=0.03). The incidences of any CK and cardiac troponin T elevation were slightly lower in statin-treated than in control patients (14.4% versus 20.9%, P=0.3, and 17.9% versus 22.4%, P=0.5, respectively).

Interpretation:

Among patients undergoing stenting of a de novo stenosis, preprocedural statin therapy was associated with a reduction in the incidence of large post PCI CK elevations (myonecrosis). Evidence continues to accumulate with respect to the various non-lipid-lowering effects of statins, which include improvement in endothelial function, and reductions in oxidative stress, inflammation, and platelet activation. The effectiveness of statins in secondary cardiovascular prevention has been adequately demonstrated in a number of prospective trials and a previous cohort study had demonstrated survival benefit with preprocedural statin in patients undergoing coronary intervention. Similar benefits have been observed among patients undergoing CABG.

References:

Herrmann J, Lerman A, Baumgart D, et al. Preprocedural Statin Medication Reduces the Extent of Periprocedural Non-Q-Wave Myocardial Infarction. Circulation October 22, 2002; 106:2180 - 2183.

Clinical Topics: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Lipid Metabolism, Stress

Keywords: Inflammation, Myocardial Infarction, Creatine Kinase, Research Personnel, Lipids, Oxidative Stress, Troponin T, Constriction, Pathologic, Platelet Activation, Angioplasty, Balloon, Coronary


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