SummaryHMG-CoA reductase inhibitors (statins) reduce major adverse cardiac events (MACE) and mortality in patients with acute coronary syndrome. We investigated whether early statin therapy would be effective at reducing MACE in patients with acute myocardial infarction (AMI).A total of 1,159 patients were analyzed. They were grouped by initiation time of statin administration after admission as follows: group I; n = 945, ≤ 48 hours, group II; n = 214, > 48 hours.Cardiovascular risk factors and noncardiac comorbidities were not different between the two groups. ST-elevation MI as initial diagnosis was more prevalent in group I (68.4% versus 59.3%, P = 0.013). In-hospital mortality was not different in the two groups (0.8% versus 0.5%, P = 0.483). In one-year clinical follow-up, MACE and repercutaneous coronary intervention were lower in group I (17.8% versus 24.6%, P = 0.016, 10.2% versus 15.5%, P = 0.021, respectively). However, there was no difference in mortality (3.8% versus 4.7%, P = 0.319). In multivariate analysis, statin initiation within 48 hours after admission was an independent predictor of one-year MACE (OR 1.49, 95% CI = 1.00-2.21, P = 0.045).Consequently, early statin therapy within 48 hours after admission reduced MACE at one-year follow-up in patients with AMI. ( In addition to lowering low-density lipoprotein (LDL) levels, statins have pleiotropic effects such as improved endothelial function, 3) inflammation, 4) and reduced coronary artery thrombus formation. 5)Acute coronary syndrome (ACS) results from myocardial ischemia due to coronary plaque rupture and patients with ACS suffer from recurrent cardiac events. Many recent studies have demonstrated the efficacy of statins in patients with ACS. The A to Z trial showed a favorable trend toward reduction of major adverse cardiac events (MACE) by early initiation of an aggressive statin regimen in ACS patients. 6) In the PROVE IT-TIMI 22 trial, intensive statin therapy (80 mg of atorvastatin daily) within 10 days after admission provided greater protection against death or MACE than those of a standard regimen (40 mg of pravastatin daily) in patients with ACS patients. 7)Heeschen, et al showed withdrawal of chronic statin treatment during ACS may abrogate the beneficial effects of statins. 8)Statin therapy is beneficial not only in patients with ACS, but also those with acute myocardial infarction (AMI). In the IDEAL trial, an intensive statin regimen (atorvastatin 80 mg/ day) reduced nonfatal MI in patients with previous MI compared with usual statin therapy (simvastatin 20 mg/day). 9) Lenderink, et al demonstrated that very early statin therapy (within 24 hours after admission) was associated with reduced mortality in patients presenting with ST-elevation MI. 10)However, the time of statin initiation varied in many studies and several studies showed negative results for early statin therapy in ACS patients. [11][12][13] Thus, in the present study we evaluated the efficacy of early statin therapy after ACS, especially AMI, to determine whether i...
Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.
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