Does pravastatin therapy affect cardiac enzyme levels after percutaneous coronary intervention?

Abstract

Serum cardiac enzyme elevation after percutaneous coronary intervention (PCI), a relatively common complication, is a prognostic determinant of long-term outcome in patients who undergo these procedures. Statins are postulated to reduce such complications. This study investigated the short-term effects of pravastatin on serum creatine kinase myocardial isoform (CK-MB) and serum cardiac troponin I (cTpI) levels after elective PCI. Of 93 patients studied, 72 (77.4%) were men, and 21 (22.6%) were women (mean age, 58.9+/-11.0 y). Patients were randomly divided into 3 groups before they underwent elective PCI. Preoperatively, group 1 patients (n=30) received pravastatin 10 mg/d, and group 2 patients (n=29) received pravastatin 40 mg/d. Control group patients (n=34) received no lipid-lowering medication. Serum CK-MB and serum cTpI levels were measured preoperatively and then again at 6, 24, and 36 h postoperatively. Demographic features of patients and characteristics of the PCI procedure, including number of vessels/lesions and duration and number of inflations, did not differ among groups (P>.05). Mean serum CK-MB and serum cTpI levels were significantly increased after PCI in all patients (P<.001). When compared with control group patients, those given pravastatin did not experience significantly lowered postprocedural serum CK-MB or serum cTpI levels (P>.05). Preprocedural pravastatin therapy at dosages of 10 mg/d and 40 mg/d seems inadequate for preventing serum cardiac enzyme elevations during short-term follow-up after PCI. Additional research on this topic is recommended.

Clinical Benefit of Statin Pretreatment in Patients Undergoing Percutaneous Coronary Intervention

“…The pre-PCI bolus of unfractionated heparin was similar: 5000 IU in the studies by Yun et al 19 and Jia et al, 26 50 to 80 IU/kg in the study by Veselka et al, 22 70 to 100 IU/kg in the studies by Bozbas et al 24 and Cay et al, 28 100 IU/kg in the study by Hara et al, 27 and 70 IU/kg in the 3 ARMYDA trials, 16,18,20 the 2 studies by Briguori et al, 17,21 and the study by Kinoshita et al 25 In STATIN STEMI (Efficacy of HighDose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction), 23 weight-adjusted unfractionated heparin was given to achieve a target activated clotting time of Ͼ300 seconds in the absence of glycoprotein IIb/IIIa inhibitors and 200 to 300 seconds with glycoprotein IIb/IIIa inhibitors. Bivalirudin was used instead of unfractionated heparin in 10% of patients in ARMYDA-RECAPTURE 20 and enoxaparin in 37% of those in the study by Yun et al 19 Patients in all studies were pretreated with aspirin; the ARMYDA trials and STATIN STEMI 16,18,20,23 used 600 mg of clopidogrel as a loading dose, 5 studies 19,21,22,24,28 used a 300-mg loading dose, 3 studies 17,25,26 used either ticlopidine or clopidogrel (75 mg/d) starting Ն3 days before PCI, and ticlopidine or cilostazol was given in the study by Hara et al 27 Glycoprotein IIb/IIIa inhibitors were not used in 4 studies, 22,24,25,27 whereas such agents were administered, at the discretion of the operator, in the following proportions of patients in the other studies: 52% in the studies by Briguori et al, 17 24% in ARMYDA-ACS, 18 20% in ARMYDA 16 and in the study by Jia et al, 26 14% in NAPLES (Novel Approaches for Preventing or Limiting Events) II 21 and in the study by Cay et al, …”

“…In the last few years, prospective randomized studies have evaluated the issue of whether a statin pretreatment, with fixed doses of a specific agent for a short, definite period, may provide periprocedural cardioprotection in the setting of PCI; the majority of such studies demonstrated a benefit, 16 -21,23,25-28 but they did not include large numbers of patients, and 2 studies were not confirmatory. 22,24 Therefore, only pooled analyses that include a large patient population may help to achieve definitive results; a meta-analysis 34 was initially performed on this issue, but it had relevant limitations because it included only 2 prospective trials, which were added into the same analysis as retrospective studies. Three other meta-analyses [35][36][37] have been published recently that demonstrated the effectiveness of a statin pretreatment in the setting of PCI, but those investigations did not include the newest randomized studies, were conducted at a study level, did not perform time-to-event and subgroup analyses, did not evaluate occurrence of combined and individual MACE, and considered the incidence of periprocedural myocardial infarc- tion only according to the per trial definition.…”

“…Bivalirudin was used instead of unfractionated heparin in 10% of patients in ARMYDA-RECAPTURE 20 and enoxaparin in 37% of those in the study by Yun et al 19 Patients in all studies were pretreated with aspirin; the ARMYDA trials and STATIN STEMI 16,18,20,23 used 600 mg of clopidogrel as a loading dose, 5 studies 19,21,22,24,28 used a 300-mg loading dose, 3 studies 17,25,26 used either ticlopidine or clopidogrel (75 mg/d) starting Ն3 days before PCI, and ticlopidine or cilostazol was given in the study by Hara et al 27 Glycoprotein IIb/IIIa inhibitors were not used in 4 studies, 22,24,25,27 whereas such agents were administered, at the discretion of the operator, in the following proportions of patients in the other studies: 52% in the studies by Briguori et al, 17 24% in ARMYDA-ACS, 18 20% in ARMYDA 16 and in the study by Jia et al, 26 14% in NAPLES (Novel Approaches for Preventing or Limiting Events) II 21 and in the study by Cay et al, 28 12% in ARMYDA-RECAPTURE, 20 7% in the study by Yun et al, 19 and 22% in STATIN STEMI. 23 There were no differences in periprocedural antithrombotic therapies between high-dose statin pretreatment and control groups in any of the studies.…”

“…Outcome data were available through 30 days for all patients of the included studies, except those by Bozbas et al, 24 Jia et al, 26 and Cay et al, 28 which collected data only on in-hospital events. In addition, the study by Veselka et al, 22 who did not participate in the patient-level meta-analysis, did not evaluate the 30-day clinical outcome.…”

“…Other MACE end points were evaluated for consistency, including death, myocardial infarction, target-vessel revascularization, or stent thrombosis by 30 days, as well as both MACE end points using only spontaneous myocardial infarction rather than both spontaneous infarction and periprocedural infarction. The components of the MACE end points were also evaluated individually.Outcome data were available through 30 days for all patients of the included studies, except those by Bozbas et al, 24 Jia et al, 26 and Cay et al, 28 which collected data only on in-hospital events. In addition, the study by Veselka et al, 22 who did not participate in the patient-level meta-analysis, did not evaluate the 30-day clinical outcome.…”