- 作者：Carlo Briguori ; Gabriella Visconti ; Amelia Focaccio ; Bruno Golia ; Alaide Chieffo ; Alfredo Castelli ; Marco Mussardo ; Matteo Montorfano ; Bruno Ricciardelli ; Antonio Colombo
- 关键词：statin ; angioplasty ; stent ; complication ; myocardial infarction
- 刊名：Journal of the American College of Cardiology
- 出版年：2009
- 出版时间：1 December 2009
- 年：2009
- 卷：54
- 期：23
- 页码：2157-2163
- 全文大小：629 K
Objectives
Atorvastatin administered at least 7 days before the percutaneous coronary intervention (PCI) reduces the rate of periprocedural myocardial infarction (MI). It is unknown whether a single, high (80 mg) loading dose of atorvastatin may reduce the rate of periprocedural MI.Background
Periprocedural MI is a prognostically important complication of PCI.
Methods
The day before the elective PCI, 668 statin-naive patients were randomly assigned to atorvastatin 80 mg (atorvastatin group; n = 338) or no statin treatment (control group; n = 330). Creatine kinase-myocardial isoenzyme (CK-MB) (upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (ULN 0.10 ng/ml) were assessed before and 6 and 12 h after the intervention. Periprocedural MI was defined as a CK-MB elevation >3× ULN alone or associated with chest pain or ST-segment or T-wave abnormalities.
Results
The incidence of a periprocedural MI was 9.5 % in the atorvastatin group and 15.8 % in the control group (odds ratio: 0.56; 95 % confidence interval: 0.35 to 0.89; p = 0.014). Median CK-MB peak after PCI was 2.10 ng/ml (interquartile range 1.00 to 12.50 ng/ml) in the atorvastatin group and 3.20 ng/ml (interquartile range 1.37 to 16.07 ng/ml) in the control group (p = 0.014). The incidence of cardiac troponin I elevation >3× ULN was 26.6 % in the atorvastatin group and 39.1 % in the control group (odds ratio: 0.56; 95 % confidence interval: 0.40 to 0.78; p < 0.001).
Conclusions
A single, high (80 mg) loading (within 24 h) dose of atorvastatin reduces the incidence of periprocedural MI in elective PCI.