Effect of a Single High Loading Dose of Rosuvastatin on Percutaneous Coronary Intervention for Acute Coronary Syndromes

Study Questions:

What is the benefit of preloading with high-dose rosuvastatin in patients undergoing percutaneous coronary intervention (PCI)?

Methods:

The authors randomized a total of 125 patients with non–ST-segment elevation acute coronary syndrome to pretreatment with rosuvastatin (20 mg 2-4 hours before PCI, n = 62) or placebo (n = 63). All the patients received subsequent long-term rosuvastatin treatment (10 mg/d). The primary endpoint of the trial was the 30-day incidence of major adverse cardiac events (death, myocardial infarction, or unplanned revascularization).

Results:

Rosuvastatin use was associated with a reduction in the primary endpoint (8.1% vs. 22.2%, p < 0.01), with the difference being entirely attributed to a reduced incidence of myocardial infarction (8.1% vs. 22.2%; p < 0.01). Patients in the rosuvastatin arm were less likely to have postprocedural elevation in creatine kinase-myocardial band and troponin I at 6 hours, 24 hours, and 3 days. Patients randomized to rosuvastatin had an attenuated increase in levels of high-sensitivity C-reactive protein, interleukin-6, and monocyte chemotactic protein after PCI.

Conclusions:

Patients randomized to high-dose rosuvastatin prior to PCI had lower risk of post-PCI myocardial infarction and inflammation.

Perspective:

This study adds to the growing body of evidence supporting a beneficial role for preprocedural statin therapy in patients undergoing PCI (Patti G, et al., Circulation 2011;123:1622-32). The suggestions of benefit are strong enough without any major downside, and statin therapy should be considered part of preprocedural therapy for all patients undergoing PCI.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, ACS and Cardiac Biomarkers, Nonstatins, Novel Agents, Statins, Interventions and ACS

Keywords: Incidence, Myocardial Infarction, Acute Coronary Syndrome, C-Reactive Protein, Creatine Kinase, Biological Markers, Troponin I, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Interleukin-6, Percutaneous Coronary Intervention


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