Impact Of A Single High Loading Dose Of Atorvastatin Before Percutaneous Coronary Intervention On Incidence Of PCI-related Myocardial Infarction In Patients With Unstable Angina

Impact of a Single High Loading Dose of Atorvastatin before Percutaneous Coronary Intervention on incidence of PCI-related Myocardial Infarction in Patients with Unstable AnginaBackground:Small myocardial infarctions after percutaneous coronary intervention have been associated with higher risk of cardiac events during follow-up.Relate studies have suggested that statins may lower the risk of procedural myocardial injury. However, this threrapy has not been tested in patients with unstable angina. Objective:PCI-related MI Seriously affect the quality of PCI treatment and Increase the long-term mortality. This randomized study was designed to study the impact of a single high loading dose of atorvastatin administrated before percutaneous coronary intervention on incidence of PCI-related MI in patients with unstable angina. Methods:1. Patients Population. From August 2009 to January 2010,56 patients with unstable angina hospitalization in affiliated hospital of luzhou medical college scheduled for elective coronary angiography. Diagnostic criteria Meet《Guideline of diagnosis and treatment for unstable angina pectoris and non-ST elevation myocardial infarction 2007》.Exclusion criteria were:①ST-segment elevation acute MI;②non-ST-segment elevation MI;③Serious increase in liver enzymes (ALT/AST>3×ULN);④left ventricular ejection fraction<30%;⑤creatinine>265umol/L.2.Study design:A total of 56 patients were included in this study. The day before the procedure,all eligible patients (n=56) were randomly assigned to atorvastatin 80mg treatment and conventional therapy of cardiovascular medicine (atorvastatin group, n=28) or conventional therapy of cardiovascular medicine (control group, n=28).3.Preprocedure management. All patients were enquired the detail of Diabetes mellitus, Systemic hypertension, Hypercholesterolemia, Current smokers, Familyhistory. CK-MB(ULN3.5ng/ml),cTnT(ULN0.035ng/ml)and CRP(ULN3mg/L)were measured before procedure. All patients treated with atorvastatin (20 mg/day), clopidogrel(75mg/day),Aspirin(100 mg/day) three days before procedure. P-Blockers,ACE inhibitors and nitrates used according to the conditions of patients.4.PCI procedure.Stents were implanted according to current Guideline for PCI. All patients received a 70anti-XaIU/kg Enoxaparine. 5.Post-procedure management. All patients were discharged on atorvastatin (20mg/day), clopidogrel(75mg/day),Aspirin(100mg/day) after PCI. CK-MB,cTnT and CRP were assessed before,24h after PCI. The primary end point was PCI-related MI difmed as CK-MB elevation>3 X ULN. Results:1.Preprocedure. There were no significant differences in the most relevant clinical characteristics in the 2 groups;Biochemical characteristics and angiographic characteristics were similar in the 2 groups.There were no instances of a significant increase in serum liver enzymes (ALT and AST levels>3×ULN). 2.Postprocedure. The level of CK-MB,cTnT, CRP were significantly elevation 24h after PCI.The incidence of PCI-related MI defined as CK-MB elevation>3 X ULN was 7.1% in the atorvastatin group and 28.6% in the control group(P=0.036).The incidence of cTnT elevation>3×ULN vs 10.7% in the atorvastatin group and 35.7% in the control group(P=0.028).Conclusion:1.A single high (80mg) loading dose of atorvastatin administered within 24h before PCI is effective in reducing the incidence of PCI-related MI.2.PCI-related Myocardial Infarction associate with elevation of CRP level, a single high (80mg) loading dose of atorvastatin administered within 24h before PCI is effective in reducing the CRP level after PCI.