Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention: results of the ARMYDA-ACS randomized trial.
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.
Patti
Giuseppe
G
Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
Pasceri
Vincenzo
V
Colonna
Giuseppe
G
Miglionico
Marco
M
Fischetti
Dionigi
D
Sardella
Gennaro
G
Montinaro
Antonio
A
Di Sciascio
Germano
G
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
D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin