Efficacy Of Atorvastatin Sequential Therapy In Patients Undergoing Percutaneous Coronary Intervention

Objectives:This study was designed to investigate whether an atorvastatin Sequential therapy periprocedural percutaneous coronary intervention protects patients from periprocedural myocardial damage.Background:Previous ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) studies demonstrated that short-term pre-treatment with atorvastatin reduces myocardial infarction during PCI in statin-naive patients with both stable angina and acute coronary syndromes.Method:A total of 90 patients (age 66±11 years,22 women) with stable angina 3 (3.3%) Unstable angina31(34.4%) or non-ST-segment elevation acute coronary syndromes 15(16.7%)and ST- segment elevation Myocardial infarction 41(45.6%)and chronic statin therapy 5(5.6%) undergoing PCI were randomized to atorvastatin Sequential therapy group (80 mg/d before intervention, with a further 40-mg pre-procedural dose,40 mg/d postoperative after the first month,20mg/d from the scondery month to long-term maintain [n=44]) or atorvastatin Routine therapy group (20mg/d From the hospital to long-term maintain, [n=46]). The primary end point was 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unplanned revascularization).Results:The primary end point occurred in 9.1% of patients treated with atorvastatin Sequential therapy group and in 23.9% in the atorvastatin Routine therapy group (p=0.025); this difference was mostly driven by reduction in periprocedural myocardial infarction. There was lower incidence of post-procedural creatine kinase-myocardial band or troponin-I elevation greater than the upper limit of normal in the atorvastatin Sequential therapy group and atorvastatin Routine therapy group (15.9% and34.8%, p=0.04). Multivariable analysis identified atorvastatin Sequential therapy and as a predictor of decreased risk of 30-day incidence of major adverse cardiac events (OR:0.40,95%CI:0.20 to 0.60; 69.3% RRR,p=0.035) mainly in patients with acute coronary syndromes (68% relative risk reduction; p=0.068).Conclusions:The atorvastatin Sequential therapy trial suggests that atorvastatin Sequential therapy improves the clinical outcome of patients undergoing PCI. These findings may support a strategy of routine reload with high-dose atorvastatin early before intervention.