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

Abstract

The aim of this study was to compare the effect of a single high-dose rosuvastatin versus atorvastatin preloading in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI.) Methods: A total of 99 patients presented with STEMI and were randomly divided into three groups—a control group (n = 33) with no statin treatment, an atorvastatin group (n = 33) with a single 80 mg atorvastatin dose and the rosuvastatin group (n = 33) with a single 40 mg rosuvastatin dose in the emergency room (ER) prior to PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) were recorded, and ST-segment resolution was measured. Results: CTFC was significantly lower for the atorvastatin group (p-value < 0.01) than in the control group. A final TIMI flow grade 3 was achieved in 32 (97.0%) patients in the rosuvastatin group and 28 (84.8%) patients in the atorvastatin group compared with only 25 (75.8%) patients in the control group (p = 0.014). Peak CK-MB in the rosuvastatin group (263.2 [207.2–315.6]) and the atorvastatin group (208 [151.0–314.1]) was lower compared to that in the control group (398.4 [303.9–459.3]); p < 0.001. Conclusions: A single extensive dose of lipophilic atorvastatin prior to primary PCI in STEMI patients showed better improvement in microvascular myocardial perfusion compared to hydrophilic rosuvastatin.

Efficacy of single high-dose statin prior to percutaneous coronary intervention in acute coronary syndrome: a systematic review and meta-analysis

“…After exclusion, 17 full-text studies were assessed for the eligibility. At the end, 15 studies [ 15 – 29 ] were included in our data synthesis.…”

“…Nine studies [ 16 , 17 , 19 , 21 , 23 – 27 ] used atorvastatin medication before PCI, while five studies [ 18 , 20 , 22 , 28 , 29 ] used rosuvastatin. One study [ 15 ] used either atorvastatin or rosuvastatin. The control groups, in their entirety, did not receive a high single dose of statin as a pretreatment prior to the PCI procedure.…”

“…The intervention group consisted of 3090 patients, while the control group comprised 3117 patients. In all studies utilizing atorvastatin, a single 80 mg dose was administered; however, two studies [ 18 , 28 ] opted for a 20 mg single dose, and four studies [ 15 , 20 , 22 , 29 ] favored a 40 mg single dose of rosuvastatin. The mean age in the population receiving statins was 59.78 ± 3.4 years.…”

“…Additionally, the average duration of follow-up in studies that reported this information was approximately 6.28 months. A majority of the included studies predominantly featured patients with STEMI [ 15 , 17 , 19 – 23 , 26 , 27 ], with a single study [ 28 ] incorporating patients with NSTEMI. The remaining studies [ 16 , 18 , 24 , 25 , 29 ] encompassed a broader spectrum of ACS patients without specific categorization by ACS subtype.…”

“…2 ). Six studies [ 15 , 17 , 18 , 20 , 27 , 29 ] were categorized as having high risk of performance bias. However, it is worth noting that all the studies were categorized as having an unclear bias, particularly in the domain of detection bias, attributed to unexplained factors influencing the outcome assessment.…”