Effect Of Routine Dosage Of Statin Therapy Prior To Elective Percutaneous Coronary Intervention On Periprocedural Myocardial Injury

Objective: Periprocedural myocardial injury is one of the most importantcomplications of percutaneous coronary intervention (PCI) and is associatedwith adverse outcomes. And statins exert a number of protective effectsinvolving the improvement of endothelial function, stabilization ofatherosclerotic plaque, decrease of oxidative stress and inflammation, andinhibition of thrombogenic response besides reduction in LDL andtriglycerides. Now, it has been proved that high dose loading of statins beforePCI can reduce the incidence of periprocedural myocardial injury, but it is stillunclear that the effect of routine dosage of statin therapy prior to elective PCIon periprocedural myocardial injury. So, this research focuses on the impact ofpretreatment with statins of routine dose prior to elective PCI onperiprocedural myocardial injury.Methods: From August2006to December2010,293consecutivepatients with CHD undergoing elective PCI in our center were retrospectivelyanalyzed, stratified according to the status of preprocedural statin medication.The statin therapy group was consisted of168patients, with a mean of56.4±9.0years, and66.10%were males. These168patients received1of thefollowing statins for at least3days before PCI: atorvastatin (66.6%),simvastatin (23.2%), Fluvastatin (7.7%), Rosuvastatin (1.8%), pravastatin(0.6%). The no statin therapy group was consisted of125patients, with amean age of56.5±10.8years, and74.10%were males. Before PCI, all thepatients were administered oral aspirin75-150mg once a day, clopidogrel75mg once a day and a regular use of LMWH subcutaneously twice a day atleast3days. LMWH was used until12hours before PCI. Most of the baselineclinical characteristics and angiographic and interventional characteristics of the two study groups were matching. Blood samples were collected20-24hours after PCI to test the markers of periprocedural myocardial injury. Majoradverse cardiac events including death, myocardial infarction, recurrentangina and emergent revascularization during hospitalization were recorded.Statistical analysis: Continuous variables were expressed as mean±standarddeviation or median (lower quartile, upper quartile), and were compared byStudent's t test or Mann-Whitney rank sum test. Discrete variables wereexpressed as counts and percentages, group comparison was made bychi-square test. Multivariate analyses were performed using logistic regressionto identify predictors of periprocedural myocardial infarction ［cTnI≥3×ULN (upper limit of normal)］.Results: The overall incidences of cTnI elevation were19.1%, and22.0%occurred in the statin therapy group,15.2%in the no statin therapygroup. The incidences of cTnI elevation≥3×ULN were3.6%and4.8%inthe statin therapy and no statin therapy group, respectively. There was nosignificant difference between the two groups with respect to the rate of cTnIelevation after PCI. The overall incidences of postprocedural elevation ofMYO were1.4%, and0.6%occurred in the statin therapy group,2.4%in theno statin therapy group, with no significant difference between the two groups.In the multivariate model, the number of stents deployed per patient wasidentified as the only independent predictor of procedure-related myocardialinfarction based on postprocedural cTnI elevation≥3×ULN (OR:2.123,95%CI:1.037-4.348, P=0.040). No major adverse cardiac events took place inthe2groups during hospitalization.Conclusions: Routine dosage of statin therapy before elective PCI seemsto be not enough to prevent periprocedural myocardial injury in elective PCI.