The Effects And Mechanisms Of High Loading Dose Rosuvastatin Therapy Before Percutaneous Coronary Intervention In Patients With Acute Coronary Syndrome

ObjectiveThis study was designed to investigate whether high loading dose rosuvastatin therapy before percutaneous coronary intervention (PCI) protects patients from periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE), and to investigate the mechanisms underlying myocardial protection provided by high loading statins therapy before PCI.MethodsA total of67patients with non-ST-segment elevation acute coronary syndrome (NSETACS) were enrolled in the study. Patients scheduled for elective coronary intervention were randomized to pretreatment with high loading rosuvastatin therapy group(20mg12h before PCI, with a further20mg2h preprocedure dose [n=31], the trial group) or control group(no statins use before PCI[n=36]). Cardiac troponin I (cTnI), vascular cell adhesion molecule-1(VCAM-1) and matrix metalloproteinase-9(MMP-9) were evaluated immediately before PCI and after24h. The30-day incidence of major adverse cardiac events (MACE, including death, myocardial infarction, ischemic stroke) was evaluated in both groups.Results1. There were no significant differences of clinical characteristics between the two groups, such as age, gender composition, history of hypertension, blood cholesterol, smoking, creatinine;2. After PCI, incidence of periprocedural myocardial injury was higher in control group than in trial group (30.6%versus9.7%, p<0.05);3. VCAM-1and MMP-9levels were not different before intervention in either group. At24h after PCI, significant attenuation of VCAM-1and MMP-9elevation occurred in the trial group than control group (231±60vs.262±53ng/ml, p<0.05and199±54vs.240±59ng/ml, p<0.05);4. The30-day incidence of MACE occurred in36.1%of patients treated with high loading rosuvastatin therapy group and in12.9%in the control group (p<0.05).Conclusion1. High loading dose rosuvastatin therapy prior to PCI reduces PMI and improves outcomes in patients with ACS;2. High loading dose rosuvastatin therapy prior to PCI could inhibit the increase of VCAM-1and MMP-9after PCI;3. The reduction of PMI and MACE after high loading dose rosuvastatin therapy is associated with attenuation of the inflammatory response and improvement of plaque stable.