Reduction of Peri - Procedural Myocardial injury by Loading dose of Atorvastatin during Elective Percutaneous Coronary Intervention

Abstract

Introduction:Coronary heart disease is one of the leading causes of death in the developed world as well as in the developing countries like Bangladesh. A population based study found the prevalence of ischemic heart disease to be 6.5 per thousand in Bangladesh. 1 PCI has become one of the cardinal treatment strategies for coronary artery disease. Technical advances have expanded the capabilities of balloon angioplasty. Despite these advances, the incidence of post procedural cardiac marker elevation has not substantially decreased since the first serial assessment 20 years back. As of now, these post procedural cardiac marker elevations are considered 'peri-procedural myocardial injury' (PMI) with worse long-term outcome. 2 PMI is synonymous with peri-procedural myocardial infarction in most of the cases. In patients with normal baseline values, elevations of cardiac marker level above 99 th percentile of upper reference limit are indicative of periprocedural myocardial necrosis. By convention, increases of bio-markers greater than 3×99th percentile upper reference limit have been designated as defining PCI-related myocardial infarction. 3 Incidence of PMI may vary depending on choice of bio-marker assay, cut-off values and frequencies of blood analyses. In non-selective multi-center series post procedural elevation of creatine kinase Myocardial band (CK-MB) mass and Cardiac Troponin I (cTn-I) above upper reference limit were found in 23±12% and 27±12% of patients respectively. 2 The overall incidence of post procedure CK-MB elevation was found in different studies were18.7%, 22.0% and 25.2%. [4][5][6] In one study periprocedural MI was found about 40%. 7 Different patient-related factors, lesion characteristics and procedure-related factors are considered as putative risk factors for PMI. 2,5 Original Articles Reduction of Peri -Procedural