High Dose Atorvastatin Therapy In Acute Myocardial Infarction

Aim: To evaluate the prognostic benefit and safety of high dose atorvastatin consecutive therapy on the prognosis of patients with acute myocardial infarctionMethods: 200 consecutive inpatients in the cardiology departments of the Second Affiliated Hospital of Soochow University were included in this study from June 2010 to September 2014. All patients underwent emergency percutaneous coronary intervention(PCI) within 12 hours of disease onset. Patients were randomized into fortified therapy group and standard therapy group, respectively. Patients in fortified therapy group received 80 mg of preoperational atorvastatin followed by a daily dosage of 40 mg daily for one month, then 20 mg of atorvastatin daily was given to each patient. In the standard therapy group, patients were prescribed 20 mg of preoperational atorvastatin followed by a daily dosage of 20 mg. Myocardial perfusion immediately after PCI, rate of 50% ST segment fall in 2 hours of reperfusion therapy, perioperative cardiac troponin T, peak Nt-pro BNP and HS-CRP were compared between the two groups. Recent and long-term serum lipid profile, blood glucose, hepatic and renal function, creatinine kinase were also compared during follow up period. Additionally, major adverse cardiovascular events(MACE) were recorded and cardiac function and structure assessment was performed.Results: Significant higher instant rate of TIMI 3 reperfusion was observed in the fortified therapy group(P<0.05). There was no significant difference in the Rate of 50% ST segment fall in 2 hours of reperfusion therapy between the 2 groups(P>0.05). There was no significant difference in the perioperative cardiac troponin T and peak NT-pro BNP level between fortified and conventional therapy group. There were also no significant difference in HS-CRP level 12 hour and 3 days after intervention therapy, respectively. However, we observed significantly decreased HS-CRP level in fortified group compared with conventional therapy group(P<0.05). After one month, LDL-C level between the 2 groups showed no considerable discrepancy, nevertheless we did find that LDL-C was significantly decreased in the fortified group compared with conventional therapy group 6 month and 12 months after the procedure. There was no significant difference in the satisfactory rate of LDL-C control between the 2 groups 1 month and 6 months after the procedure, however substantially increased rate was shown in the fortified group after 12 months. There were no difference in LVEF and left ventricular diameter between the 2 groups, while significant amelioration of these parameters was seen 6 and 12 months after operation. MACE rate decreased significantly 1 month, 6 months and 12 months after the operation(P<0.05). Subgroup analysis showed no difference in the re-infarction and revascularization rate between the 2 groups. 6 months and 12 months mortality rates were significantly lower in the fortified group(P<0.05). There were no significant difference in recurrent angina and post infarction heart failure rates between the 2 groups. Fortified therapy further decreased MACE risk after 1 month, 6 months and 12 months follow up(RR 0.118, 95%CI 0.015~0.936, P=0.043; RR 0.311, 95%CI 0.101~0.955, P=0.041; RR 0.284, 95%CI 0.094~0.861, P=0.026), while drug-eluting stent(DES) significantly decreased this index, respectively(RR 0.113, 95%CI 0.029~0.440, P=0.002; RR 0.123, 95%CI 0.046~0.334, P=0.001; RR 0.208, 95%CI 0.085~0.506, P=0.001). Patients with cardiac function more advanced than class III increased MACE risk(RR 3.157, 95%CI 1.234~8.077, P=0.016). 60 subjects underwent coronary angiography(CAG) 8.45±4.71 months after the procedure, revealing mild decreased intra-stent restenosis rate in the fortified group compared with control, however with no statistical significance. Fortified group showed a significantly higher mild hepatic dysfunction rate compared with conventional therapy. Both groups did not show severe hepatic and renal failure, gastrointestinal dysfunction, myopathy, newly onset diabetes, and Contrast-induced nephropathy, indicating favorable compliance and safety.Conclusion: Loading dose of atorvastatin in the perioperative period or early after PCI can significantly ameliorate myocardium perfusion, inhibit inflammatory reaction, decrease LDL-C level, increase LDL-C satisfactory rate, reverse myocardium remodeling, improve left ventricular function and decrease risk of MACE, respectively. Fortified therapy also showed optimized safety and obedience. DES application can significantly decrease risk of MACE compared with BMS. Moderate and severe cardiac dysfunction is associated with increased MACE rate and considered to be an independent risk factor for cardiovascular events.