Caridoprotective Effect Of Loading Dose Atorvastatin Pretreatment In Patients With Acute ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective：This study was to observe clinical benefits of loading dose atorvastatin prior toprimary PCI in patients with STEMI.Methods：A total of179STEMI patients were randomized to receive intensive orconventional atrovastatin treatment prior to primary PCI.84patients were belongedto the intensive treatment arm (80mg before PCI,40mg/d in the first30-day afterprocedure, then20mg/d) and95patients were belonged to control arm (20mg/d afterPCI). The end points are listed below:1. The primary end points are1-yearincidences of all-cause death and MACEs, the MACEs was including cardiac death,nonfatal MI, target vessel revascularization, and morderate-to-severe heart failure(rehospitalization due to heart failure);2. The secondary primary end points areincluding postprocedural TIMI flow grade, STR at90min post-procedure;3. Tocalculate the peak time of CK-MB and the AUC of CK-MB curve;4. To record thevalue of LVEF and LVEDd at1week post-PCI.Results：1. No statistical significance was observed in the general clinical and PCI datumof patients between the two groups (all P>0.05).2. The postprocedural TIMI flow grade of the intensive treatment arm was lowerthan control arm (2.71±0.53vs.2.46±0.78, P=0.014). The intensive treatment armhad a higher TIMI flow grade2/3rate than control arms (96.4%vs.88.4%, P=0.046).Significant increase of the STR at90min post-PCI occurred in the intensive treatmentarm vs. control arm (57.36±30.25%vs.46.73±29.08%, P=0.012).3. The LVEF after1week post-PCI was significantly higher in the intensive armvs. control arm (60.04±9.01%vs.57.31±9.29%, P=0.048).4. According to the result of1year follow-up, no significant difference wasobserved in MACEs between the two arms (12.5%vs.16.3%, P=0.502).5. To classify all179patients by aspiration thrombectomy and atorvastatin treatment into4groups, including A group (conventional therapy alone), B group(thrombus aspirating alone), C group (intensive statins therapy) and D group(thrombus aspirating, plus intensive statins therapy). The results showed that asignificant increase of STR in B group vs. A group (57.87±26.44%vs.36.70±27.89%, P<0.001).Conclusions:1. In STEMI patients undergoing primary PCI, immediate coronary flow andmyocardial perfusion were improved with the intensive atorvastatin treatment.2. The improvement of left ventricular systolic function is associated withatorvastatin load.3. Intensive atorvastatin treatment did not show a significant reduction ofMACEs, but did show a trend of reducing the incidence rate of MACEs.4. Thrombus aspiration may improve myocardial perfusion.