Prevention of Peri-procedural Myocardial Injury Using a Single High Loading Dose of Rosuvastatin

Abstract

A single high loading dose of rosuvastatin reduces the incidence of peri-procedural myocardial necrosis and infarction effectively.

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 19 and 22% in STATIN STEMI.…”

“…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.…”

“…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.…”

“…Another limitation is that the included studies used different dosing strategies of statins, and the time points at which cardiac markers were measured after PCI were variable. Moreover, 4 of the 13 studies 22,24,26,28 did not collect 30-day data, and the MACE for those 4 studies only included periprocedural myocardial infarction. Finally, because the antithrombotic treatments used in the various trials appear to be different, the robustness of meta-driven conclusions may be limited and the clinical benefit of high-dose statins observed in the present meta-analysis may be affected; a standardized approach to antithrombotic therapies in a larger randomized trial would help eliminate this confounder.…”

“…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.…”