Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction.
OBJECTIVE
Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI.


RESULTS
Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure.Incidence of peri-procedural myocardial injury was assessed by analysis of creatinine kinase myocardial isoenzyme (CK-MB: upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (cTn I, ULN 0.10 ng/ml) before, 6 and 12 h after the intervention. A large non-Q-wave myocardial infarction was defined as a CK-MB elevation >5 times ULN alone or associated with chest pain or ST segment or T wave abnormalities. Median CK-MB peak after PCI was 1.70 (interquartile ranges 1.10-3.70) ng/ml in the Statin group and 2.20 (1.30-5.60) ng/ml in the Control group (p=0.015). Median peak of cTnI after PCI was 0.13 (0.05-0.45) ng/ml in the Statin group and 0.21 (0.06-0.85) ng/ml in the Control group (p=0.033). The incidence of a large non-Q-wave myocardial infarction was 8.0% in the Statin group and 15.6% in the Control group (p=0.012: OR=0.47; 95% CI=0.26-0.86). The incidence of cTnI elevation >5 times ULN was 23.5% in the Statin group and 32% in the Control group (p=0.043: OR=0.65; 95% CI=0.42-0.98). By logistic regression analysis, the independent predictors of CK-MB elevation >5 times ULN after PCI were intra-procedural angiographic complications (OR=9.36; 95% CI=3.06-28.64; p<0.001), statin pre-treatment (OR=0.33; 95% CI=0.13-0.86; p=0.023) and age >65 years (OR=2.58; 95% CI=1.09-6.11; p=0.031).


CONCLUSIONS
Pre-procedural statin therapy reduces the incidence of large non-Q-wave myocardial infarction after PCI.
Briguori
Carlo
C
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio 2, I-80121 Naples, Italy. briguori.carlo@hsr.it
Colombo
Antonio
A
Airoldi
Flavio
F
Violante
Anna
A
Focaccio
Amelia
A
Balestrieri
Pasquale
P
Paolo Elia
Pietro
P
Golia
Bruno
B
Lepore
Stefano
S
Riviezzo
Guido
G
Scarpato
Pierfranco
P
Librera
Mariateresa
M
Bonizzoni
Erminio
E
Ricciardelli
Bruno
B
D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015607:Stents
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors