Clinical effect of preoperative high-dose atorvastatin against no-reflow after PCI

Abstract

The aim of the present study was to evaluate the use of preoperative high-dose atorvastatin to prevent the no-reflow phenomenon after percutaneous coronary intervention (PCI). A total of 138 patients with ST-segment elevation myocardial infarction, admitted from March 2014 to January 2015, were enrolled and randomly divided into 3 groups of 46 individuals each. The groups included a control group in which patients were not treated with atorvastatin before PCI; a conventional-dose atorvastatin treatment group in which patients received a single dose of 20 mg at bedtime one day prior to PCI; and a high-dose atorvastatin treatment group in which patients were treated with 40 mg divided in two doses the day before PCI. The treatment effects were assessed by re-examining the echocardiography, high-sensitivity C-reactive protein and brain natriuretic peptide (BNP) levels after the PCI. The follow-up examinations included determinations of ultrasound imaging indicators and the contact with patients was maintained for a whole year. The CTFC (frame), pro-BNP, CK-MB peak and WMSI levels of the patients in the high-dose treatment group were significantly lower than those in the conventional dose or the control group. Trombolysis in myocardial infarction ≤2 and myocardial blush grade ≤1 levels were significantly lower than those in the conventional dose group (P=0.01) or those in the control group (P=0.01), although the echocardiographic indicators of the three groups were not significantly different (P<0.05). Nevertheless, it was found that there were significantly fewer adverse cardiovascular events in the high-dose group (P<0.05 in both cases). During the follow-up period, thromboembolism and restenosis were most infrequent in the high-dose atorvastatin group. Based on our findings the oral administration of high-dose atorvastatin before bedtime, one day before the procedure, can effectively prevent no-reflow cases, reduce adverse events and improve the long-term prognosis for acute coronary syndrome patients after PCI.

Meta-analysis of the effect of high-intensity statin on coronary microvascular dysfunction

“…A total of 1126 related articles were retrieved from PubMed, Cochrane and Embase databases, and 28 duplicate articles were excluded. The remaining 1098 articles were first read by title and abstract, and then the full text of potential related articles was read to determine whether the inclusion criteria were fit, and finally 20 RCTS were included [11][12][13][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The specific inclusion process is shown in Figure 1.…”

Enhanced-Dose Statins for ST-Segment Elevation Myocardial Infarction Patients after Emergency Percutaneous Coronary Intervention

“…However, mechanical damage can occur during PCI treatment, resulting in a vascular endothelial tear. Thus, a large amount of subcutaneous tissue is exposed to blood, which can trigger an inflammatory response, damage myocardial cells, activate coagulation functions, and increase the risk of MACE [ 14 , 15 ]. Previously, dual antiplatelet and antithrombotic interventions mainly focused on perioperative PCI.…”

Comparison of the Treatment Efficacy of Rosuvastatin versus Atorvastatin Loading Prior to Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

“…In many STEMI cases, after primary PCI, myocardial tissue cannot be perfused despite restoration of blood flow within infarct-related arteries—this is called the no-reflow phenomenon [ 1 , 2 ]. Although the pathophysiology of no-reflow is poorly understood, it is supposed to occur through several factors involving microdistal embolization and ischemia–reperfusion injury [ 3 , 4 , 5 ], which is a predictor of future myocardium remodeling and diminished cardiac function [ 5 , 6 ]. Many studies performed on STEMI patients ending with previous use of statins may improve coronary blood flow after PCI [ 5 , 7 , 8 ].…”

“…Although the pathophysiology of no-reflow is poorly understood, it is supposed to occur through several factors involving microdistal embolization and ischemia–reperfusion injury [ 3 , 4 , 5 ], which is a predictor of future myocardium remodeling and diminished cardiac function [ 5 , 6 ]. Many studies performed on STEMI patients ending with previous use of statins may improve coronary blood flow after PCI [ 5 , 7 , 8 ]. Statins have beneficial effects on the vascular system through non-lipid mechanisms such as providing positive actions on platelet adherence, thrombosis, endothelial function, stability of plaque, and inflammation, which are called pleiotropic effects [ 9 , 10 , 11 ].…”