title: Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial.
abstract: OBJECTIVE
  This study sought to investigate potential protective effects of atorvastatin in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Randomized studies have shown that pretreatment with atorvastatin may reduce periprocedural myocardial infarction in patients with stable angina during elective PCI; however, this therapy has not been tested in patients with ACS.
  
  
  METHODS
  A total of 171 patients with non-ST-segment elevation ACS were randomized to pretreatment with atorvastatin (80 mg 12 h before PCI, with a further 40-mg preprocedure dose [n = 86]) or placebo (n = 85). All patients were given a clopidogrel 600-mg loading dose. All patients received long-term atorvastatin treatment thereafter (40 mg/day). The main end point of the trial was a 30-day incidence of major adverse cardiac events (death, myocardial infarction, or unplanned revascularization).
  
  
  RESULTS
  The primary end point occurred in 5% of patients in the atorvastatin arm and in 17% of those in the placebo arm (p = 0.01); this difference was mostly driven by reduction of myocardial infarction incidence (5% vs. 15%; p = 0.04). Postprocedural elevation of creatine kinase-MB and troponin-I was also significantly lower in the atorvastatin group (7% vs. 27%, p = 0.001 and 41% vs. 58%, p = 0.039, respectively). At multivariable analysis, pretreatment with atorvastatin conferred an 88% risk reduction of 30-day major adverse cardiac events (odds ratio 0.12, 95% confidence interval 0.05 to 0.50; p = 0.004).
  
  
  CONCLUSIONS
  The ARMYDA-ACS trial indicates that even short-term pretreatment with atorvastatin may improve outcomes in patients with ACS undergoing early invasive strategy. These findings may support routine use of high-dose statins before intervention in patients with ACS.
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Giuseppe
authors: G
authors: Patti
authors: Vincenzo
authors: V
authors: Pasceri
authors: Giuseppe
authors: G
authors: Colonna
authors: Marco
authors: M
authors: Miglionico
authors: Dionigi
authors: D
authors: Fischetti
authors: Gennaro
authors: G
authors: Sardella
authors: Antonio
authors: A
authors: Montinaro
authors: Germano
authors: G
authors: Di Sciascio
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000069059:Atorvastatin; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage*; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin