Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Does Pre-Treatment with High Dose Atorvastatin Prevent Microvascular Dysfunction after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome?

  • Lee, Bong-Ki (Division of Cardiology, Kangwon National University School of Medicine) ;
  • Koo, Bon-Kwon (Division of Cardiology, Seoul National University Hospital) ;
  • Nam, Chang-Wook (Division of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Doh, Joon-Hyung (Division of Cardiology, Inje University Ilsan-Paik Hospital) ;
  • Chung, Woo-Young (Division of Cardiology, Seoul National University Boramae Medical Center) ;
  • Cho, Byung-Ryul (Division of Cardiology, Kangwon National University School of Medicine) ;
  • Fearon, William F. (Department of Cardiovascular Medicine, Stanford University Medical Center)
  • Received : 2015.04.27
  • Accepted : 2015.08.13
  • Published : 2016.07.30
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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 ($14.1{\pm}5.0$ vs. $19.2{\pm}9.3U$, 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.

Keywords

Acknowledgement

Supported by : Korean Society of Cardiology

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