Beneficial Effects of High-Dose Atorvastatin Pretreatment on Renal Function in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention

Abstract

Objectives: To investigate whether preprocedural high-dose atorvastatin decreases the incidence of contrast-induced nephropathy (CIN) and protects the renal function after emergency percutaneous coronary intervention (PCI). Methods: Statin-naive patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency PCI (n = 161) randomly received atorvastatin (80 mg, n = 78, ATOR group) or placebo [n = 83, control (CON) group] followed by long-term atorvastatin (40 mg/day). The primary end point was incidence of CIN. Results: In the ATOR group, 2.6% of the patients developed CIN versus 15.7% in the CON group (p = 0.01). In the ATOR group, postprocedural serum creatinine was significantly lower (93.4 ± 17.1 vs. 112.6 ± 23.3 µmol/l at 48 h and 84.2 ± 14.2 vs. 95.3 ± 17.7 µmol/l at 72 h, both p < 0.0001) and in the CON group, peak serum cystatin C was lower (0.51 ± 0.14 vs. 0.61 ± 0.13 mg/l, p < 0.0001). Atorvastatin pretreatment was independently associated with a decreased risk of CIN (OR 0.084, 95% CI 0.015–0.462, p = 0.004). The proportion of alanine aminotransferase >3 × upper limit of the normal value within 1 month was 3.85 versus 1.20% (ATOR vs. CON group, p = 0.57). Conclusion: Preprocedural high-dose atorvastatin prevents CIN and protects the renal function in patients with acute STEMI undergoing emergency PCI.

Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI

“…Effectiveness of several preventive strategies for CIN have been reported including preprocedural intravenous volume expansion with isotonic saline or sodium bicarbonate, antioxidant therapy with N-acetylcysteine, theophylline or ascorbic acid and use of low-or iso-osmolality CM [32,[34][35][36]. In addition, high-dose statin treatment may decrease the risk of renal failure and CIN in patients with CAD [10][11][12]. However, in patients with AMI, the timely initiation of these preventive therapies may not be possible due to the emergency of the situation.…”

“…Vasoconstriction, oxidative stress, free radical damage, endothelial dysfunction and inflammation have been proposed as pathophysiological mechanisms of CIN [8]. Many preventive measures have been recommended to decrease the incidence of CIN, but, these precautions may not be applied to patients with critical diseases such as acute myocardial infarction (AMI) due to its emergent condition [7][8][9][10][11][12].…”

Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

“…37 Our studies included newer studies that used lower volume of contrast media, which caused less tubular toxicities. [16][17][18][19][20]27 Therefore, our meta-analysis successfully reveals the benefit of statins for the prevention of CIAKI.…”

“…Jo et al 22 Zhou et al 23 Wang et al 24 Xinwei et al 14 Toso et al 25 Country Ozhan et al 26 Acikel et al 28 Patti et al 18 de Oliveira et al 27 Quintavalle et al 19 Country Turkey Li et al 20 Han et al 16 Leoncini et al 16 Country Statins for prevention of contrast-induced acute kidney injury 5 rather than a fixed-effect model. Statistical heterogeneity was assessed using the Cochran's Q test.…”

“…Several studies have demonstrated a protective effect of statins for CIAKI prevention. [12][13][14][15][16][17][18][19][20] Conversely, a few studies showed no significant beneficial effect of statins for prevention of CIAKI. [21][22][23][24][25][26][27][28] To assess whether statins had beneficial effects on prevention of CIAKI, we performed this meta-analysis to investigate the effect of statins on the incidence of CIAKI between statin and control groups.…”